Organization
MEDA CARE VANS OF WAUKESHA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN V DOHERTY (PRESIDENT)
(414) 264-2000
Entity
Organization
Contact information
Practice address
N15W24817 BLUEMOUND RD, PEWAUKEE, WI 53072-4620
(262) 650-1000
(262) 650-1029
Mailing address
N15W24817 BLUEMOUND RD, PEWAUKEE, WI 53072-4620
(262) 650-1000
(262) 650-1029
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41459700
—
WI
Enumeration date
07/16/2008
Last updated
07/16/2008
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