Healthcare Provider Details

I. General information

NPI: 1124354261
Provider Name (Legal Business Name): ASAP TRANSPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2009
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7117 CLINTON RD SUITE 4
LOVES PARK IL
61111
US

IV. Provider business mailing address

7117 CLINTON RD SUITE 4
LOVES PARK IL
61111
US

V. Phone/Fax

Practice location:
  • Phone: 815-654-2727
  • Fax: 815-282-0692
Mailing address:
  • Phone: 815-654-2727
  • Fax: 815-282-0692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY J GRUBA
Title or Position: GENERAL MANAGER
Credential:
Phone: 815-654-2727