Healthcare Provider Details

I. General information

NPI: 1508105131
Provider Name (Legal Business Name): NON-EMERGENCY MEDICAL TRANSPORTATION OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5567 N ELSTON AVE
CHICAGO IL
60630-1314
US

IV. Provider business mailing address

P.O. BOX 5988 DEPT. 20-5056
CAROL STREAM IL
60197-5988
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-8999
  • Fax: 773-774-4744
Mailing address:
  • Phone: 773-774-8999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number StateIL

VIII. Authorized Official

Name: BRIAN WITEK
Title or Position: PRESIDENT
Credential:
Phone: 773-774-8999