Provider Demographics
NPI:1124354261
Name:ASAP TRANSPORT, LLC
Entity type:Organization
Organization Name:ASAP TRANSPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-654-2727
Mailing Address - Street 1:7117 CLINTON RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111
Mailing Address - Country:US
Mailing Address - Phone:815-654-2727
Mailing Address - Fax:815-282-0692
Practice Address - Street 1:7117 CLINTON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111
Practice Address - Country:US
Practice Address - Phone:815-654-2727
Practice Address - Fax:815-282-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-25
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100012383Medicaid
IL=========001Medicaid
WI100012383Medicaid