Provider Demographics
NPI:1932551595
Name:AVINCENNNA MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:AVINCENNNA MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSEYNOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-865-8018
Mailing Address - Street 1:434 CALLAN AVE
Mailing Address - Street 2:GW
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2973
Mailing Address - Country:US
Mailing Address - Phone:773-865-8018
Mailing Address - Fax:
Practice Address - Street 1:434 CALLAN AVE
Practice Address - Street 2:GW
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2973
Practice Address - Country:US
Practice Address - Phone:773-865-8018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)