Organization
BRONCO EXPRESS COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ALLEN LEMMEN (OPERATIONS MANAGER)
(269) 548-6219
Entity
Organization
Contact information
Practice address
124 LAKE ST, KALAMAZOO, MI 49001-2807
(269) 343-3000
(269) 343-3309
Mailing address
6020 BRIARCLIFF PATH APT A, KALAMAZOO, MI 49009-7449
(269) 343-3000
(269) 343-3309
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B200
MTM
—
Enumeration date
12/27/2018
Last updated
12/27/2018
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