Provider Demographics
NPI:1669632543
Name:RECOVERY MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:RECOVERY MEDICAL TRANSPORT
Other - Org Name:KURT L KOWALSKI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:LONNIE
Authorized Official - Last Name:KOWALSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-939-5542
Mailing Address - Street 1:2500 PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-3462
Mailing Address - Country:US
Mailing Address - Phone:262-939-5542
Mailing Address - Fax:262-554-6462
Practice Address - Street 1:2500 PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-3462
Practice Address - Country:US
Practice Address - Phone:262-939-5542
Practice Address - Fax:262-554-6462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41450300343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI590305OtherDEAN HEALTH PLAN SOUTH EAST
WI590305OtherCHILDRENS COMMUNITY HEALTH PLAN
WI41450300Medicaid