Healthcare Provider Details

I. General information

NPI: 1033609839
Provider Name (Legal Business Name): COLES COUNTY TRANSPORTATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 W LINCOLN AVE STE 4
CHARLESTON IL
61920-2461
US

IV. Provider business mailing address

PO BOX 251
CHARLESTON IL
61920-0251
US

V. Phone/Fax

Practice location:
  • Phone: 217-345-2941
  • Fax: 217-345-7122
Mailing address:
  • Phone: 217-345-2941
  • Fax: 217-345-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRITTANY MICHELLE MCGRATH
Title or Position: VICE PRESIDENT
Credential:
Phone: 217-345-2941