NPIMap

Organization Active NPI

Med Group Transportation LLC

  • Non-emergency Medical Transport (VAN)
  • Mequon, WI
National Provider Identifier
1184866253
Registry record updated Apr 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-emergency Medical Transport (VAN)Taxonomy code 343900000X
License
376ZYF Issued in WI
Legal business name
MED GROUP TRANSPORTATION LLC
Practice address
11412 N Port Washington Rd Ste 215
Mequon, WI 53092-3450
Phone
(414) 755-0500
Fax
(414) 755-1763
NPI assigned
Apr 3, 2009
Last updated
Apr 3, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Dariko Mekvabishvili
Title
President
Phone
(414) 755-0500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-emergency Medical Transport (VAN) 343900000X 376ZYF WI Primary

Addresses

Primary practice location

11412 N Port Washington Rd Ste 215
Mequon, WI 53092-3450

Mailing address

11412 N Port Washington Rd Ste 215
Mequon, WI 53092-3450
Phone (414) 755-0500

Other identifiers 1

IdentifierTypeStateIssuer
100002648MedicaidWI

National Provider Directory

National Provider Directory

Locations

11412 N Port Washington Rd
Ste 215
Mequon, WI 53092
Phone (414) 755-0500

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1238716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238716800000",
    "number": "1184866253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11412 N PORT WASHINGTON RD STE 215",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923450",
            "telephone_number": "414-755-0500",
            "fax_number": "414-755-1763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11412 N PORT WASHINGTON RD STE 215",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923450",
            "telephone_number": "414-755-0500",
            "fax_number": "414-755-1763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED GROUP TRANSPORTATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-03",
        "last_updated": "2009-04-03",
        "status": "A",
        "authorized_official_last_name": "MEKVABISHVILI",
        "authorized_official_first_name": "DARIKO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-755-0500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "WI",
            "license": "376ZYF",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002648",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.