MEDICARE: CREATED2CARELTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343800000X	Secured Medical Transport (VAN)		IL

General Provider Information

NPI Number	:	1063954519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATED2CARELTD

Provider Business Mailing Address
First Line	:	5632 S EMERALD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-2939
Country	:	US
Telephone Number	:	708-203-0343
Fax Number	:

Provider Business Practice Location Address
First Line	:	5632 S. EMERALD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621
Country	:	US
Telephone Number	:	708-203-0343
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HERMAN DEGRAFFENREID
Credential	:
Telephone Number	:	708-203-0343

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/15/2016

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