Provider Demographics
NPI:1053845024
Name:EAS-Z MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:EAS-Z MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-742-7052
Mailing Address - Street 1:120 E ALBERT ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1360
Mailing Address - Country:US
Mailing Address - Phone:608-742-7052
Mailing Address - Fax:877-743-4117
Practice Address - Street 1:120 E ALBERT ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1360
Practice Address - Country:US
Practice Address - Phone:608-742-7052
Practice Address - Fax:877-743-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)