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General NPI Number Information
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NPI Number | 1770931255
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Entity Type | Organization
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Legal Business Name | DYNAMIC TRANSPORT SOLUTIONS LLC
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 6109 W. BARRY
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City | CHICAGO
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State | IL
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Zip | 60634
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Country | US
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Telephone | 773-888-2019
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Fax |
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Provider Business Mailing Address
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Address Line | 6109 W BARRY AVE
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City | CHICAGO
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State | IL
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Zip | 60634-4030
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Country | US
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Telephone | 773-888-2019
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. EMANUEL J AGOSTO
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Credential |
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Telephone | 773-888-2019
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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 | A22321075177
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License Number State | IL
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