Organization
VA TRANSPORTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIKTOR AZIMOV (PRESIDENT)
(414) 712-8232
Entity
Organization
Contact information
Practice address
411 W WILLOW TER, FOX POINT, WI 53217-2662
(414) 807-4413
Mailing address
411 W WILLOW TER, FOX POINT, WI 53217-2662
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41491700
—
WI
Enumeration date
08/05/2015
Last updated
08/05/2015
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