Provider Demographics
NPI:1265771927
Name:MEDVAN TRANSPORT LLC
Entity type:Organization
Organization Name:MEDVAN TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:LANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-293-4386
Mailing Address - Street 1:N9211 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:NESHKORO
Mailing Address - State:WI
Mailing Address - Zip Code:54960-9031
Mailing Address - Country:US
Mailing Address - Phone:920-293-4386
Mailing Address - Fax:920-293-4386
Practice Address - Street 1:N9211 COUNTY RD N
Practice Address - Street 2:
Practice Address - City:NESHKORO
Practice Address - State:WI
Practice Address - Zip Code:54960-9031
Practice Address - Country:US
Practice Address - Phone:920-293-4386
Practice Address - Fax:920-293-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)