Provider Demographics
NPI:1851688766
Name:BWCT TRANSPORTATION
Entity Type:Organization
Organization Name:BWCT TRANSPORTATION
Other - Org Name:BWCT TRANSPORTATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGRAFFENREID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-203-0343
Mailing Address - Street 1:PO BOX 1833
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-4833
Mailing Address - Country:US
Mailing Address - Phone:708-396-9950
Mailing Address - Fax:708-260-9396
Practice Address - Street 1:14343 S YATES AVE
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:IL
Practice Address - Zip Code:60633-2252
Practice Address - Country:US
Practice Address - Phone:708-396-9950
Practice Address - Fax:708-260-9396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-30
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343900000X343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)