Provider Demographics
NPI:1396466595
Name:DOUBLE D MEDITRANS LLC
Entity type:Organization
Organization Name:DOUBLE D MEDITRANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ETIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-626-6616
Mailing Address - Street 1:2520 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:BURNHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60633-2258
Mailing Address - Country:US
Mailing Address - Phone:312-626-6616
Mailing Address - Fax:
Practice Address - Street 1:2520 E STATE ST
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:IL
Practice Address - Zip Code:60633-2258
Practice Address - Country:US
Practice Address - Phone:312-626-6616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)