Active NPI
Supanawong Xiong
- Non-emergency Medical Transport (VAN)
- Eau Claire, WI
National Provider Identifier
1639944390
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Non-emergency Medical Transport (VAN)
- License
- X5207800017205
- Practice address
- 1515 Golf Rd
Eau Claire, WI 54701-7457 - Phone
- (651) 274-6118
- NPI assigned
- Nov 21, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Non-emergency Medical Transport (VAN) | 343900000X | X5207800017205 | WI | Primary |
Addresses
Primary practice location
1515 Golf Rd
Eau Claire, WI 54701-7457
Mailing address
1515 Golf Rd
Eau Claire, WI 54701-7457
Phone (651) 274-6118
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| X5207800017205 | WI | MD | Non-emergency Medical Transport (VAN) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700524800000",
"number": "1639944390",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 GOLF RD",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547017457",
"telephone_number": "651-274-6118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 GOLF RD",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "547017457",
"telephone_number": "651-274-6118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "XIONG",
"first_name": "SUPANAWONG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-21",
"last_updated": "2023-11-21",
"certification_date": "2023-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "343900000X",
"taxonomy_group": "",
"desc": "Non-emergency Medical Transport (VAN)",
"state": "WI",
"license": "X5207800017205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eau Claire, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.