MEDICARE: THE COMMISSION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1245507102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE COMMISSION

Provider Business Mailing Address
First Line	:	3806 N 41ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3031
Country	:	US
Telephone Number	:	414-759-1107
Fax Number	:

Provider Business Practice Location Address
First Line	:	3806 N 41ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3031
Country	:	US
Telephone Number	:	414-759-1107
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RISHON R HARALSON
Credential	:
Telephone Number	:	414-759-1107

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	11/21/2011

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Directions to “THE COMMISSION ” Practice Location

Language	Start Address	Practice Location

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