Provider Demographics
NPI:1083888747
Name:BLUE-CHIP MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:BLUE-CHIP MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-821-6674
Mailing Address - Street 1:10815 S EBERHART AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-3709
Mailing Address - Country:US
Mailing Address - Phone:773-821-6674
Mailing Address - Fax:773-821-9545
Practice Address - Street 1:10815 S EBERHART AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3709
Practice Address - Country:US
Practice Address - Phone:773-821-6674
Practice Address - Fax:773-821-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6062801343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6062801Medicaid