MEDICARE: DIRECT PASSAGE NEMT SERVICES LLC

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)

General Provider Information

NPI Number	:	1619551579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECT PASSAGE NEMT SERVICES LLC

Provider Business Mailing Address
First Line	:	1730 N MONITOR AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4026
Country	:	US
Telephone Number	:	773-354-5230
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 N MONITOR AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4026
Country	:	US
Telephone Number	:	773-354-5230
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	KEARIA WIGGINS
Credential	:
Telephone Number	:	773-354-5230

Provider Enumeration Date	:	05/07/2021
Last Update Date	:	05/07/2021

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