Provider Demographics
NPI:1922872134
Name:MIDWEST MEDICAL TRANSPORT LLC
Entity Type:Organization
Organization Name:MIDWEST MEDICAL TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:K
Authorized Official - Last Name:MATTESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-308-4113
Mailing Address - Street 1:PO BOX 3727
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5792 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3219
Practice Address - Country:US
Practice Address - Phone:800-562-3396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance