Provider Demographics
NPI:1689983579
Name:MCS MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:MCS MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:BREKHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-325-5411
Mailing Address - Street 1:1040 S MILWAUKEE AVE
Mailing Address - Street 2:#140
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-6373
Mailing Address - Country:US
Mailing Address - Phone:847-325-5411
Mailing Address - Fax:847-325-5414
Practice Address - Street 1:1040 S MILWAUKEE AVE
Practice Address - Street 2:#140
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-6373
Practice Address - Country:US
Practice Address - Phone:847-325-5411
Practice Address - Fax:847-325-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343800000X343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid