Healthcare Provider Details

I. General information

NPI: 1619794500
Provider Name (Legal Business Name): EAZY MEDICAL TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 E MAWMAN AVE
BEACH PARK IL
60087-2469
US

IV. Provider business mailing address

9880 E MAWMAN AVE
BEACH PARK IL
60087-2469
US

V. Phone/Fax

Practice location:
  • Phone: 224-303-5122
  • Fax:
Mailing address:
  • Phone: 224-303-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LAUREN H MOLLER
Title or Position: OWNER
Credential:
Phone: 224-303-5122