Provider Demographics
NPI:1568493021
Name:PROFESSIONAL MEDICAL TRANSPORTATION SERVICES, INC
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL TRANSPORTATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZZERINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-259-9675
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-0457
Mailing Address - Country:US
Mailing Address - Phone:847-577-8811
Mailing Address - Fax:847-577-7967
Practice Address - Street 1:8 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1962
Practice Address - Country:US
Practice Address - Phone:847-259-9675
Practice Address - Fax:847-963-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL89583416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635699OtherBCBS
ILP00285632OtherRR MEDICARE
IL=========OtherTRICARE FOR LIFE
ILP00285632OtherRR MEDICARE
IL01635699OtherBCBS
IL01635699OtherBCBS