MEDICARE: WILS TRANSPORTATION

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	:	1700465424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILS TRANSPORTATION

Provider Business Mailing Address
First Line	:	845 15TH ST STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8098
Country	:	US
Telephone Number	:	619-856-5821
Fax Number	:	877-868-9686

Provider Business Practice Location Address
First Line	:	845 15TH ST STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8098
Country	:	US
Telephone Number	:	619-856-5821
Fax Number	:	877-868-9686

Authorized Official
Title or Position	:	DIRECTING MANAGER
Name	:	MANILAY AMY JACKSON
Credential	:
Telephone Number	:	619-856-5821

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	10/04/2021

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Directions to “WILS TRANSPORTATION ” Practice Location

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