Healthcare Provider Details

I. General information

NPI: 1154984631
Provider Name (Legal Business Name): INFINITY AND BEYOND TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9343 S SANGAMON ST
CHICAGO IL
60620-2734
US

IV. Provider business mailing address

9343 S SANGAMON ST
CHICAGO IL
60620-2734
US

V. Phone/Fax

Practice location:
  • Phone: 773-699-4281
  • Fax: 773-496-0909
Mailing address:
  • Phone: 773-699-4281
  • Fax: 773-496-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335U00000X
TaxonomyOrgan Procurement Organization
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MS. MILDRED WHITE
Title or Position: MANAGING MEMBER
Credential:
Phone: 773-699-4281