Organization
EXECUTIVE TRANSPORT SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAMIAN JAMARIO COLEMAN CLASS HLP (CEO)
(414) 688-3152
Entity
Organization
Contact information
Practice address
3416 W SAINT PAUL AVE, MILWAUKEE, WI 53208-4123
(414) 688-3152
Mailing address
3416 W SAINT PAUL AVE, MILWAUKEE, WI 53208-4123
(414) 688-3152
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
343900000X
WI
Other
Enumeration date
10/18/2013
Last updated
10/18/2013
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