Provider Demographics
NPI:1528014933
Name:MIDWEST MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL SERVICES INC
Other - Org Name:ADVANCE AMBULANCE
Other - Org Type:Doing Business As
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:773-774-8875
Mailing Address - Street 1:PO 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:630-510-4501
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:630-510-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL10 89633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01629912OtherBCBS
IL132743900OtherDEPT OF LABOR OWCP
IL590014475OtherRR MEDICARE
IL590014475OtherRR MEDICARE
IL625860Medicare PIN
IL590014475OtherRR MEDICARE