MEDICARE: CHICAGO MEDICAL MOBILITY TRANSPORTATION SERVICES

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	:	1740589464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO MEDICAL MOBILITY TRANSPORTATION SERVICES

Provider Business Mailing Address
First Line	:	80 E CERMAK RD
Second Line	:	UNIT A1
City	:	CHICAGO
State	:	IL
Zip	:	60616-2123
Country	:	US
Telephone Number	:	312-328-6661
Fax Number	:	312-328-6662

Provider Business Practice Location Address
First Line	:	80 E CERMAK RD
Second Line	:	UNIT A1
City	:	CHICAGO
State	:	IL
Zip	:	60616-2123
Country	:	US
Telephone Number	:	312-328-6661
Fax Number	:	312-328-6662

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMANDA UNICE CRAWFORD
Credential	:
Telephone Number	:	312-328-6661

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/21/2011

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