Provider Demographics
NPI:1154560159
Name:PDQ MEDICAL TRANSIT LLC
Entity type:Organization
Organization Name:PDQ MEDICAL TRANSIT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PERNSTEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-748-2262
Mailing Address - Street 1:880 S GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1681
Mailing Address - Country:US
Mailing Address - Phone:715-748-2262
Mailing Address - Fax:715-748-2262
Practice Address - Street 1:880 S GIBSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1681
Practice Address - Country:US
Practice Address - Phone:715-748-2262
Practice Address - Fax:715-748-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100001725Medicaid