Healthcare Provider Details

I. General information

NPI: 1760832695
Provider Name (Legal Business Name): MIDWEST MEDICAL TRANSPORT COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59706 AIRPORT RD
ATLANTIC IA
50022-8269
US

IV. Provider business mailing address

2155 33RD AVE
COLUMBUS NE
68601-3148
US

V. Phone/Fax

Practice location:
  • Phone: 970-903-8343
  • Fax:
Mailing address:
  • Phone: 402-562-6430
  • Fax: 402-563-0937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number5158
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number2001400
License Number StateIA

VIII. Authorized Official

Name: MR. TIM HOFFMAN
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 402-800-2934