Provider Demographics
NPI:1174703540
Name:ROYAL MEDICAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:ROYAL MEDICAL TRANSPORTATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPSHELEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-899-9399
Mailing Address - Street 1:13760 N BONNIWELL CT
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-1509
Mailing Address - Country:US
Mailing Address - Phone:414-899-9399
Mailing Address - Fax:262-236-4005
Practice Address - Street 1:13760 N BONNIWELL CT
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-1509
Practice Address - Country:US
Practice Address - Phone:414-899-9399
Practice Address - Fax:262-236-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41497600343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41497600Medicaid