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General NPI Number Information
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NPI Number | 1043131816
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Entity Type | Organization
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Legal Business Name | M A C CARE TRANSPORTATION LLC
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Dates
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Enumeration Date | 07/24/2026
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Last Update Date | 07/24/2026
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Provider Practice Location Address
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Address Line | 347 S CICERO AVE # 2S
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City | CHICAGO
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State | IL
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Zip | 60644-4905
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Country | US
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Telephone | 773-746-1399
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Fax |
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Provider Business Mailing Address
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Address Line | 3913 HAAS AVE APT 4
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City | LYONS
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State | IL
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Zip | 60534-1225
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Country | US
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Telephone | 773-746-1399
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DERRICK DAMON MCCOLLUM SR.
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Credential |
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Telephone | 773-746-1399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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