MEDICARE: MIDWEST MEDICAL TRANSPORT 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	341600000X	Ambulance

General Provider Information

NPI Number	:	1922872134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST MEDICAL TRANSPORT LLC

Provider Business Mailing Address
First Line	:	PO BOX 3727
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68103-0727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5792 ARROWHEAD DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3219
Country	:	US
Telephone Number	:	800-562-3396
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ED K MATTESON
Credential	:
Telephone Number	:	708-308-4113

Provider Enumeration Date	:	11/08/2023
Last Update Date	:	11/08/2023

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Directions to “MIDWEST MEDICAL TRANSPORT LLC ” Practice Location

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