=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740853159
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EPIC EXPRESS MEDICAL TRANSPORT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2021
-----------------------------------------------------
Last Update Date | 07/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11011 W NORTH AVE APT 137
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-2299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-822-6287
-----------------------------------------------------
Fax | 414-988-6173
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11011 W NORTH AVE APT 137
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53226-2299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-822-6287
-----------------------------------------------------
Fax | 414-988-6173
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FELISHA EDWARDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 262-822-6287
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 342000000X
-----------------------------------------------------
Taxonomy Name | Transportation Network Company
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------