Provider Demographics
NPI:1144181710
Name:DC MEDICAL TRANSPORT
Entity type:Organization
Organization Name:DC MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JETMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-288-1655
Mailing Address - Street 1:925 S OXFORD AVE UNIT C6
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3933
Mailing Address - Country:US
Mailing Address - Phone:920-288-1655
Mailing Address - Fax:
Practice Address - Street 1:925 S OXFORD AVE UNIT C6
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3933
Practice Address - Country:US
Practice Address - Phone:920-288-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)