Provider Demographics
NPI:1619551579
Name:DIRECT PASSAGE NEMT SERVICES LLC
Entity Type:Organization
Organization Name:DIRECT PASSAGE NEMT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KEARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-354-5230
Mailing Address - Street 1:1730 N MONITOR AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-4026
Mailing Address - Country:US
Mailing Address - Phone:773-354-5230
Mailing Address - Fax:
Practice Address - Street 1:1730 N MONITOR AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-4026
Practice Address - Country:US
Practice Address - Phone:773-354-5230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)