MEDICARE: AV 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)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669770731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AV TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	4958 N SANTA MONICA BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5911
Country	:	US
Telephone Number	:	414-967-7999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4958 N SANTA MONICA BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5911
Country	:	US
Telephone Number	:	414-967-7999
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANZHELIKA VINOKUR
Credential	:
Telephone Number	:	414-967-7999

Provider Enumeration Date	:	03/14/2011
Last Update Date	:	03/16/2011

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Directions to “AV TRANSPORTATION, LLC ” Practice Location

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