Healthcare Provider Details

I. General information

NPI: 1760857585
Provider Name (Legal Business Name): MVP TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2015
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 N 17TH STREET NUMBER 23
BELLEVILLE IL
62226
US

IV. Provider business mailing address

1229 N 17TH STREET NUMBER 23
BELLEVILLE IL
62226
US

V. Phone/Fax

Practice location:
  • Phone: 618-623-4422
  • Fax: 888-672-2818
Mailing address:
  • Phone: 618-623-4422
  • Fax: 888-672-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. KESU BROWN
Title or Position: VICE PRESIDENT
Credential:
Phone: 618-623-4422