Provider Demographics
NPI:1508105131
Name:NON-EMERGENCY MEDICAL TRANSPORTATION OF ILLINOIS
Entity Type:Organization
Organization Name:NON-EMERGENCY MEDICAL TRANSPORTATION OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-774-8999
Mailing Address - Street 1:P.O. BOX 5988
Mailing Address - Street 2:DEPT. 20-5056
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5988
Mailing Address - Country:US
Mailing Address - Phone:773-774-8999
Mailing Address - Fax:
Practice Address - Street 1:5567 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1314
Practice Address - Country:US
Practice Address - Phone:773-774-8999
Practice Address - Fax:773-774-4744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)