Organization
ANTIGO VANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GAIL LEVEQUE (OWNER)
(715) 627-0387
Entity
Organization
Contact information
Practice address
726 BIRCH ST, ANTIGO, WI 54409-1710
(715) 627-0387
(715) 627-1203
Mailing address
726 BIRCH ST, ANTIGO, WI 54409-1710
(715) 627-0387
(715) 627-1203
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41473300
PROVIDER NUMBER
WI
Enumeration date
03/13/2009
Last updated
03/13/2009
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