Provider Demographics
NPI:1558033035
Name:SELECTED TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:SELECTED TRANSPORTATION, LLC
Other - Org Name:SELECTED TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XIONG
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-391-9018
Mailing Address - Street 1:4311 SPRINGFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-0909
Mailing Address - Country:US
Mailing Address - Phone:920-391-9018
Mailing Address - Fax:
Practice Address - Street 1:4311 SPRINGFIELD CT
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-0909
Practice Address - Country:US
Practice Address - Phone:920-391-9018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-02
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)