Icwm, LLC

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

License

USDOT 1427478 IN Issued in IN

Legal business name

ICWM, LLC

Practice address

59742 Wren LN
South Bend, IN 46614-4007

Phone

(574) 231-1998

Fax

(574) 231-1997

NPI assigned

Jun 30, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Walter Willard Ballard III

Title

President

Phone

(574) 383-1751

Specialties & licenses 1

Addresses

Other names 1

• WCI Transportation Service Doing business as

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

{
    "created_epoch": "1183161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203552000000",
    "number": "1457558520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10037",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466800037",
            "telephone_number": "574-287-7068",
            "fax_number": "574-287-7096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59742 WREN LN",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466144007",
            "telephone_number": "574-231-1998",
            "fax_number": "574-231-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICWM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-30",
        "last_updated": "2008-02-21",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "WILLARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-383-1751",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "IN",
            "license": "USDOT 1427478 IN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WCI Transportation Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Non-emergency Medical Transport (VAN) in South Bend, IN
• Providers in South Bend, IN by specialty
• Non-emergency Medical Transport (VAN) in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2008; 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.