Organization
ICWM, LLC
Active
Other names
WCI Transportation Service
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALTER WILLARD BALLARD III (PRESIDENT)
(574) 383-1751
Entity
Organization
Contact information
Practice address
59742 WREN LN, SOUTH BEND, IN 46614-4007
(574) 231-1998
(574) 231-1997
Mailing address
PO BOX 10037, SOUTH BEND, IN 46680-0037
(574) 287-7068
(574) 287-7096
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
USDOT 1427478 IN
IN
Other
Enumeration date
06/30/2007
Last updated
02/21/2008
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