Healthcare Provider Details

I. General information

NPI: 1326486689
Provider Name (Legal Business Name): MIDWEST MEDICAL TRANSPORTATION SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 WILLIAMS ST
CALUMET CITY IL
60409-5663
US

IV. Provider business mailing address

944 WILLIAMS ST
CALUMET CITY IL
60409-5663
US

V. Phone/Fax

Practice location:
  • Phone: 708-560-5175
  • Fax:
Mailing address:
  • Phone: 708-560-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. AUSTIN OKOLO
Title or Position: PRESIDENT
Credential:
Phone: 708-560-5175