=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477950426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOST HIGH TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2014
-----------------------------------------------------
Last Update Date | 11/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 845 N SPRINGFIELD AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60651-3728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-331-0841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 845 N SPRINGFIELD AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60651-3728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-331-0841
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DONNERICO WALKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 17733310841
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | W42616074168
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------