MEDICARE: PICKUP & DROPOFF TRANSPORTATION

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)
2	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1184898025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PICKUP & DROPOFF TRANSPORTATION

Provider Business Mailing Address
First Line	:	4934 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4934 W CHICAGO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3142
Country	:	US
Telephone Number	:	773-379-4025
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. LANISHA JENKINS
Credential	:
Telephone Number	:	773-379-4025

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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Directions to “PICKUP & DROPOFF TRANSPORTATION ” Practice Location

Language	Start Address	Practice Location

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