Provider Demographics
NPI:1639502248
Name:WISCONSIN TRANSPORT SYSTEMS LLC
Entity Type:Organization
Organization Name:WISCONSIN TRANSPORT SYSTEMS LLC
Other - Org Name:WISCONSIN TRANSPORT SYSTEMS LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADLOCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:414-795-7960
Mailing Address - Street 1:4329 N 74TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1052
Mailing Address - Country:US
Mailing Address - Phone:414-795-7960
Mailing Address - Fax:
Practice Address - Street 1:4329 N 74TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1052
Practice Address - Country:US
Practice Address - Phone:414-795-7960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-19
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54527343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100024724Medicaid