Healthcare Provider Details

I. General information

NPI: 1144506452
Provider Name (Legal Business Name): URBAN MEDICAL TRANSPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S WELLS ST #1236
CHICAGO IL
60607-4529
US

IV. Provider business mailing address

800 S WELLS ST APT 1236
CHICAGO IL
60607-4540
US

V. Phone/Fax

Practice location:
  • Phone: 312-404-9528
  • Fax: 312-922-1183
Mailing address:
  • Phone: 312-404-9528
  • Fax: 312-922-1183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANESHA FULTZ
Title or Position: PRESIDENT
Credential:
Phone: 312-404-9528