Provider Demographics
NPI:1528446291
Name:A&J VANS INC
Entity type:Organization
Organization Name:A&J VANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-775-9333
Mailing Address - Street 1:333 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:VALDERS
Mailing Address - State:WI
Mailing Address - Zip Code:54245-9201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VALDERS
Practice Address - State:WI
Practice Address - Zip Code:54245-9201
Practice Address - Country:US
Practice Address - Phone:920-775-9333
Practice Address - Fax:920-775-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)