Provider Demographics
NPI:1689113292
Name:MAMAJSTRANSPORTATIONINC
Entity Type:Organization
Organization Name:MAMAJSTRANSPORTATIONINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MURILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-288-9782
Mailing Address - Street 1:17025 CREGIER AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3632
Mailing Address - Country:US
Mailing Address - Phone:708-288-9782
Mailing Address - Fax:708-566-1258
Practice Address - Street 1:17025 CREGIER AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3632
Practice Address - Country:US
Practice Address - Phone:708-288-9782
Practice Address - Fax:708-566-1258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJ52554044618343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)