Healthcare Provider Details

I. General information

NPI: 1043131816
Provider Name (Legal Business Name): M A C CARE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 S CICERO AVE # 2S
CHICAGO IL
60644-4905
US

IV. Provider business mailing address

3913 HAAS AVE APT 4
LYONS IL
60534-1225
US

V. Phone/Fax

Practice location:
  • Phone: 773-746-1399
  • Fax:
Mailing address:
  • Phone: 773-746-1399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DERRICK DAMON MCCOLLUM SR.
Title or Position: OWNER
Credential:
Phone: 773-746-1399