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General NPI Number Information
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NPI Number | 1902623457
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Entity Type | Organization
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Legal Business Name | JS MEDIVAN TRANSPORT LLC
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 10/26/2024
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Provider Practice Location Address
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Address Line | 8828 NILES CENTER RD APT 505
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City | SKOKIE
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State | IL
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Zip | 60077-5455
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Country | US
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Telephone | 847-922-2588
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Fax |
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Provider Business Mailing Address
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Address Line | 714 W DRESSER DR
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-3018
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Country | US
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Telephone | 847-922-2588
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | SARAH ZABAT
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Credential | LPN
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Telephone | 847-922-2588
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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 |
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License Number State |
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