Provider Demographics
NPI:1427282912
Name:PHOENIX TRANSPORTATION LLC
Entity type:Organization
Organization Name:PHOENIX TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:MCDOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-373-0165
Mailing Address - Street 1:16430 DANE CT E
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-1302
Mailing Address - Country:US
Mailing Address - Phone:262-373-0165
Mailing Address - Fax:262-781-7645
Practice Address - Street 1:16430 DANE CT E
Practice Address - Street 2:16430 DANE CT EAST
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-1302
Practice Address - Country:US
Practice Address - Phone:262-373-0165
Practice Address - Fax:262-781-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)