MEDICARE: SOUTHLAND TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant
2	172A00000X	Driver

General Provider Information

NPI Number	:	1730043738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHLAND TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	5469 EDISON AVE
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2943
Country	:	US
Telephone Number	:	708-502-8190
Fax Number	:

Provider Business Practice Location Address
First Line	:	11623 S LONGWOOD DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4829
Country	:	US
Telephone Number	:	708-502-8190
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MYLAN LEO SANDERS
Credential	:
Telephone Number	:	708-502-8190

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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Directions to “SOUTHLAND TRANSPORTATION LLC ” Practice Location

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