Provider Demographics
NPI:1376583633
Name:AMBULANCE TRANSPORTATION, INC
Entity Type:Organization
Organization Name:AMBULANCE TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:708-802-8101
Mailing Address - Street 1:8400 183RD PL
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-9268
Mailing Address - Country:US
Mailing Address - Phone:708-802-8101
Mailing Address - Fax:708-802-8112
Practice Address - Street 1:8400 183RD PL
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-9268
Practice Address - Country:US
Practice Address - Phone:708-802-8101
Practice Address - Fax:708-802-8112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAB TRAN GROUP LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL89543416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid