Provider Demographics
NPI:1578747002
Name:BLESSED QUALIFIED TRANSPORT CO
Entity Type:Organization
Organization Name:BLESSED QUALIFIED TRANSPORT CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PIPHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-466-3819
Mailing Address - Street 1:6815 W CAPITOL DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2070
Mailing Address - Country:US
Mailing Address - Phone:414-466-3819
Mailing Address - Fax:414-466-3881
Practice Address - Street 1:6815 W CAPITOL DR
Practice Address - Street 2:SUITE 107
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2070
Practice Address - Country:US
Practice Address - Phone:414-466-3819
Practice Address - Fax:414-466-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41484000343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41484000Medicaid