Provider Demographics
NPI:1851138218
Name:ROADWAY WI
Entity type:Organization
Organization Name:ROADWAY WI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MULKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-209-4145
Mailing Address - Street 1:777 N JEFFERSON ST STE 408
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3713
Mailing Address - Country:US
Mailing Address - Phone:414-209-4145
Mailing Address - Fax:
Practice Address - Street 1:777 N JEFFERSON ST STE 408
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3713
Practice Address - Country:US
Practice Address - Phone:414-209-4145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)