Provider Demographics
NPI:1831473172
Name:BUCKLE UP TRANSPORTATION INC
Entity Type:Organization
Organization Name:BUCKLE UP TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-349-9158
Mailing Address - Street 1:4011 W CAPITOL DR STE 205
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2557
Mailing Address - Country:US
Mailing Address - Phone:414-349-9158
Mailing Address - Fax:414-355-7502
Practice Address - Street 1:4011 W CAPITOL DR STE 205
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2557
Practice Address - Country:US
Practice Address - Phone:414-349-9158
Practice Address - Fax:414-355-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100005080343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100005080Medicaid