MEDICARE: IN MOTION TRANSPORTATION LLC

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)	979CTS	WI

General Provider Information

NPI Number	:	1336570225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN MOTION TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	5445 W FOREST HOME AVE
Second Line	:	#8
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-1450
Country	:	US
Telephone Number	:	414-391-3549
Fax Number	:

Provider Business Practice Location Address
First Line	:	5445 W FOREST HOME AVE
Second Line	:	#8
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-1450
Country	:	US
Telephone Number	:	414-391-3549
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN DOMENA
Credential	:
Telephone Number	:	414-391-3549

Provider Enumeration Date	:	12/03/2013
Last Update Date	:	12/03/2013

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Directions to “IN MOTION TRANSPORTATION LLC ” Practice Location

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