Provider Demographics
NPI:1710163001
Name:MILWAUKEE AREA TRANSPORTATION SERVICE INC
Entity Type:Organization
Organization Name:MILWAUKEE AREA TRANSPORTATION SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:EASTERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-349-1068
Mailing Address - Street 1:3619 N 58TH BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2848
Mailing Address - Country:US
Mailing Address - Phone:414-349-1068
Mailing Address - Fax:414-431-8631
Practice Address - Street 1:3619 N 58TH BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2848
Practice Address - Country:US
Practice Address - Phone:414-349-1068
Practice Address - Fax:414-431-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41486300343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41486300Medicaid