Provider Demographics
NPI:1780347385
Name:MGG TRANSPORTATION, INC
Entity type:Organization
Organization Name:MGG TRANSPORTATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHAMIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-931-1756
Mailing Address - Street 1:3612 LINCOLN HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1637
Mailing Address - Country:US
Mailing Address - Phone:866-931-1756
Mailing Address - Fax:866-273-3976
Practice Address - Street 1:3612 LINCOLN HWY STE 5
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1637
Practice Address - Country:US
Practice Address - Phone:866-931-1756
Practice Address - Fax:866-273-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7807181Medicaid