Healthcare Provider Details

I. General information

NPI: 1255399614
Provider Name (Legal Business Name): ILLINOIS MEDI-CAR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W LAKE ST
ELMHURST IL
60126
US

IV. Provider business mailing address

395 W LAKE ST
ELMHURST IL
60126
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-2012
  • Fax: 630-832-2169
Mailing address:
  • Phone: 630-832-2012
  • Fax: 630-832-2169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID B. HILL III
Title or Position: PRESIDENT
Credential:
Phone: 630-832-2012