MEDICARE: MJM 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)	343800000X	IL

General Provider Information

NPI Number	:	1598069924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJM TRANSPORTATION

Provider Business Mailing Address
First Line	:	5531 W CONGRESS PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-5013
Country	:	US
Telephone Number	:	773-242-3276
Fax Number	:

Provider Business Practice Location Address
First Line	:	5531 W CONGRESS PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-5013
Country	:	US
Telephone Number	:	773-242-3276
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. MICHAEL A WILLIS
Credential	:
Telephone Number	:	773-242-3276

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	12/28/2010

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