Provider Demographics
NPI:1013799782
Name:MIDWEST MEDICAL TRANSPORTATION, LLC.
Entity Type:Organization
Organization Name:MIDWEST MEDICAL TRANSPORTATION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:RASHONDA
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-278-2477
Mailing Address - Street 1:995 N. PONTIAC TRAIL
Mailing Address - Street 2:P.O. BOX # 57
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3323
Mailing Address - Country:US
Mailing Address - Phone:248-278-2477
Mailing Address - Fax:
Practice Address - Street 1:995 N. PONTIAC TRAIL
Practice Address - Street 2:
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3323
Practice Address - Country:US
Practice Address - Phone:248-278-2477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle