Provider Demographics
NPI:1922588755
Name:MOBILE MEDICAL TRANSPORT, INCORPORATED
Entity Type:Organization
Organization Name:MOBILE MEDICAL TRANSPORT, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-704-2855
Mailing Address - Street 1:411 MARSHALL STREET
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-5041
Mailing Address - Country:US
Mailing Address - Phone:708-704-2855
Mailing Address - Fax:
Practice Address - Street 1:411 MARSHALL STREET
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-5041
Practice Address - Country:US
Practice Address - Phone:708-704-2855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN201702101180216343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)