Provider Demographics
NPI:1538451349
Name:LETS GO TRANSPORTATION
Entity type:Organization
Organization Name:LETS GO TRANSPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-855-6268
Mailing Address - Street 1:7327 W CONGRESS ST
Mailing Address - Street 2:#6
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-5441
Mailing Address - Country:US
Mailing Address - Phone:414-855-6268
Mailing Address - Fax:414-464-7827
Practice Address - Street 1:7327 W CONGRESS ST
Practice Address - Street 2:#6
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-5441
Practice Address - Country:US
Practice Address - Phone:414-855-6268
Practice Address - Fax:414-464-7827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIS5304006175902343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100012576Medicaid