=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619335858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEL NON-MEDICAL TRANSPORTATION SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2016
-----------------------------------------------------
Last Update Date | 02/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15225 DANTE AVE
-----------------------------------------------------
City | DOLTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60419-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-323-2864
-----------------------------------------------------
Fax | 708-782-7615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15225 DANTE AVE
-----------------------------------------------------
City | DOLTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60419-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-323-2864
-----------------------------------------------------
Fax | 708-782-7615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. MATTHEW DOMONYU SAWYER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-306-9009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------