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General NPI Number Information
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NPI Number | 1427005347
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Entity Type | Organization
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Legal Business Name | BLACKHAWK MEDICAL TRANSPORTATION, INC.
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 8400 183RD PL
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City | TINLEY PARK
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State | IL
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Zip | 60477-9268
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Country | US
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Telephone | 708-532-1613
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Fax |
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Provider Business Mailing Address
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Address Line | 8400 183RD PL
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City | TINLEY PARK
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State | IL
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Zip | 60487-9205
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Country | US
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Telephone | 708-532-1613
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | MR. CHRISTOPHER J VANDENBERG
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Credential |
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Telephone | 708-532-1613
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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 | 3459
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 8959
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License Number State | IL
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