Provider Demographics
NPI:1033165675
Name:ELGIN MEDI-TRANSPORT, INC.
Entity Type:Organization
Organization Name:ELGIN MEDI-TRANSPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-697-0202
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60121-0323
Mailing Address - Country:US
Mailing Address - Phone:847-697-0202
Mailing Address - Fax:847-697-4736
Practice Address - Street 1:672 WING ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2870
Practice Address - Country:US
Practice Address - Phone:847-697-0202
Practice Address - Fax:847-697-4736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL9 70293416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL791590124OtherRAILROAD MEDICARE
IL=========001Medicaid
IL238870Medicare ID - Type UnspecifiedPRIVATE AMBULANCE