NPIMap

Organization Active NPI

Executive Transport Service LLC

  • Non-emergency Medical Transport (VAN)
  • Milwaukee, WI
National Provider Identifier
1639507155
Registry record updated Oct 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-emergency Medical Transport (VAN)Taxonomy code 343900000X
License
343900000X Issued in WI
Legal business name
EXECUTIVE TRANSPORT SERVICE LLC
Practice address
3416 W Saint Paul Ave
Milwaukee, WI 53208-4123
Phone
(414) 688-3152
NPI assigned
Oct 18, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2013

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

Authorized official

Name
Damian Jamario Coleman, CLASS HLP
Title
Ceo
Phone
(414) 688-3152

Specialties & licenses 1

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

Addresses

Primary practice location

3416 W Saint Paul Ave
Milwaukee, WI 53208-4123

Mailing address

3416 W Saint Paul Ave
Milwaukee, WI 53208-4123
Phone (414) 688-3152

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1382054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382054400000",
    "number": "1639507155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3416 W SAINT PAUL AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532084123",
            "telephone_number": "414-688-3152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3416 W SAINT PAUL AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532084123",
            "telephone_number": "414-688-3152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE TRANSPORT SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-18",
        "last_updated": "2013-10-18",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "DAMIAN",
        "authorized_official_middle_name": "JAMARIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "414-688-3152",
        "authorized_official_credential": "CLASS HLP"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "WI",
            "license": "343900000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2013; 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.