Provider Demographics
NPI:1952682361
Name:NORTHWESTERN MEDIVAN INC
Entity Type:Organization
Organization Name:NORTHWESTERN MEDIVAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-883-8677
Mailing Address - Street 1:480 BLUE HERON CIR
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-2307
Mailing Address - Country:US
Mailing Address - Phone:630-883-8677
Mailing Address - Fax:630-883-8676
Practice Address - Street 1:480 BLUE HERON CIR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-2307
Practice Address - Country:US
Practice Address - Phone:630-883-8677
Practice Address - Fax:630-883-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13204PT343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)