1669632543 NPI number — RECOVERY MEDICAL TRANSPORT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669632543 NPI number — RECOVERY MEDICAL TRANSPORT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERY MEDICAL TRANSPORT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669632543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 PINEHURST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RACINE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53403-3462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-939-5542
Provider Business Mailing Address Fax Number:
262-554-6462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 PINEHURST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RACINE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53403-3462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-939-5542
Provider Business Practice Location Address Fax Number:
262-554-6462
Provider Enumeration Date:
06/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KOWALSKI
Authorized Official First Name:
KURT
Authorized Official Middle Name:
LONNIE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
262-939-5542

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  41450300 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 590305 . This is a "DEAN HEALTH PLAN SOUTH EAST" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 590305 . This is a "CHILDRENS COMMUNITY HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 41450300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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