Healthcare Provider Details

I. General information

NPI: 1124451125
Provider Name (Legal Business Name): ONSITE MEDITRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5630 LYONS ST
MORTON GROVE IL
60053-1546
US

IV. Provider business mailing address

5630 LYONS ST
MORTON GROVE IL
60053-1546
US

V. Phone/Fax

Practice location:
  • Phone: 708-937-8125
  • Fax: 847-674-0892
Mailing address:
  • Phone: 708-937-8125
  • Fax: 847-674-0892

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. JAIME HURTADO
Title or Position: ADMINISTRATOR
Credential:
Phone: 708-715-1250