Provider Demographics
NPI:1053012302
Name:BREEZY TRANSPORTATION
Entity type:Organization
Organization Name:BREEZY TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-436-4001
Mailing Address - Street 1:408 S MAIN ST APT 7
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-4881
Mailing Address - Country:US
Mailing Address - Phone:608-436-6601
Mailing Address - Fax:
Practice Address - Street 1:408 S MAIN ST APT 7
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-4881
Practice Address - Country:US
Practice Address - Phone:608-436-6601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)