Provider Demographics
NPI:1457510802
Name:MUSTANG TRANSPORTATION INC
Entity Type:Organization
Organization Name:MUSTANG TRANSPORTATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIKTPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VODOVOZOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-329-1275
Mailing Address - Street 1:4656 W TOUHY AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1656
Mailing Address - Country:US
Mailing Address - Phone:847-329-1275
Mailing Address - Fax:
Practice Address - Street 1:4656 W TOUHY AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-1656
Practice Address - Country:US
Practice Address - Phone:847-329-1275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid