Healthcare Provider Details

I. General information

NPI: 1477003846
Provider Name (Legal Business Name): B M TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14239 WINCHESTER AVE
DIXMOOR IL
60426-1151
US

IV. Provider business mailing address

4800 S LAKE PARK AVE UNIT 2511A
CHICAGO IL
60615-2190
US

V. Phone/Fax

Practice location:
  • Phone: 773-459-0990
  • Fax: 773-285-0430
Mailing address:
  • Phone: 773-459-0990
  • Fax: 773-285-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateIL

VIII. Authorized Official

Name: PAMELA DENISE MCNAIR
Title or Position: MANAGER
Credential:
Phone: 773-459-0990