MEDICARE: CITY WIDE EXPRESS 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	343900000X	Non-emergency Medical Transport (VAN)	6820MC	IL

General Provider Information

NPI Number	:	1386951739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY WIDE EXPRESS TRANSPORTATION

Provider Business Mailing Address
First Line	:	1304 W 77TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-3730
Country	:	US
Telephone Number	:	773-994-9631
Fax Number	:	773-783-6058

Provider Business Practice Location Address
First Line	:	1304 W 77TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-3730
Country	:	US
Telephone Number	:	773-994-9631
Fax Number	:	773-783-6058

Authorized Official
Title or Position	:	OWNER
Name	:	MS. WILNESSA MIMS
Credential	:
Telephone Number	:	773-994-9631

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	09/07/2010

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Directions to “CITY WIDE EXPRESS TRANSPORTATION ” Practice Location

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