=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689983579
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCS MEDICAL TRANSPORTATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2010
-----------------------------------------------------
Last Update Date | 09/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1040 S MILWAUKEE AVE #140
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60090-6373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-325-5411
-----------------------------------------------------
Fax | 847-325-5414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1040 S MILWAUKEE AVE #140
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60090-6373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-325-5411
-----------------------------------------------------
Fax | 847-325-5414
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DIMITRIY BREKHER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-325-5411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343800000X
-----------------------------------------------------
Taxonomy Name | Secured Medical Transport (VAN)
-----------------------------------------------------
License Number | 343800000X
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------