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Organization

MED GROUP TRANSPORTATION LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. DARIKO MEKVABISHVILI (PRESIDENT)
(414) 755-0500
Entity
Organization

Contact information

Practice address
11412 N PORT WASHINGTON RD STE 215, MEQUON, WI 53092-3450
(414) 755-0500
(414) 755-1763
Mailing address
11412 N PORT WASHINGTON RD STE 215, MEQUON, WI 53092-3450
(414) 755-0500
(414) 755-1763

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
376ZYF
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100002648
WI
Enumeration date
04/03/2009
Last updated
04/03/2009
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