Provider Demographics
NPI:1588420509
Name:WIRKSAM SERVICE SOLUTIONS LLC
Entity type:Organization
Organization Name:WIRKSAM SERVICE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WISK
Authorized Official - Middle Name:WENSY
Authorized Official - Last Name:DERIFOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-853-6769
Mailing Address - Street 1:3915 S KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9619
Mailing Address - Country:US
Mailing Address - Phone:561-853-6769
Mailing Address - Fax:
Practice Address - Street 1:3915 S KENNEDY DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-9619
Practice Address - Country:US
Practice Address - Phone:561-853-6769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)