Provider Demographics
NPI:1609150572
Name:SAFEWAY MEDICAR
Entity Type:Organization
Organization Name:SAFEWAY MEDICAR
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER/OWMER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDMUNDO JR.
Authorized Official - Middle Name:HECHANOVA
Authorized Official - Last Name:CORTEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:773-458-9020
Mailing Address - Street 1:4915 NORTH MONTICELLO AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4915 N MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5653
Practice Address - Country:US
Practice Address - Phone:773-458-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:D11127417
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)