Provider Demographics
NPI:1740589464
Name:CHICAGO MEDICAL MOBILITY TRANSPORTATION SERVICES
Entity Type:Organization
Organization Name:CHICAGO MEDICAL MOBILITY TRANSPORTATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:UNICE
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-328-6661
Mailing Address - Street 1:80 E CERMAK RD
Mailing Address - Street 2:UNIT A1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2123
Mailing Address - Country:US
Mailing Address - Phone:312-328-6661
Mailing Address - Fax:312-328-6662
Practice Address - Street 1:80 E CERMAK RD
Practice Address - Street 2:UNIT A1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2123
Practice Address - Country:US
Practice Address - Phone:312-328-6661
Practice Address - Fax:312-328-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherITIN