Provider Demographics
NPI:1700465424
Name:WILS TRANSPORTATION
Entity Type:Organization
Organization Name:WILS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MANILAY
Authorized Official - Middle Name:AMY
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-856-5821
Mailing Address - Street 1:845 15TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8098
Mailing Address - Country:US
Mailing Address - Phone:619-856-5821
Mailing Address - Fax:877-868-9686
Practice Address - Street 1:845 15TH ST STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-8098
Practice Address - Country:US
Practice Address - Phone:619-856-5821
Practice Address - Fax:877-868-9686
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILS TRANSPORTATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-08
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)