Provider Demographics
NPI:1194067157
Name:BACU CASPIAN CORP
Entity type:Organization
Organization Name:BACU CASPIAN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NON-EMERGENCY MEDICAL TRANSPORT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-290-4406
Mailing Address - Street 1:4801 GROVE ST
Mailing Address - Street 2:1W
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1725
Mailing Address - Country:US
Mailing Address - Phone:773-290-4406
Mailing Address - Fax:847-983-4551
Practice Address - Street 1:4801 GROVE ST
Practice Address - Street 2:1W
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1725
Practice Address - Country:US
Practice Address - Phone:773-290-4406
Practice Address - Fax:847-983-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)