Provider Demographics
NPI:1194100925
Name:MIDWEST MEDICAL TRANSPORT INC
Entity type:Organization
Organization Name:MIDWEST MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREEM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SYED SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-748-9407
Mailing Address - Street 1:4736 N LONG AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3447
Mailing Address - Country:US
Mailing Address - Phone:630-748-9407
Mailing Address - Fax:
Practice Address - Street 1:4736 N LONG AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3447
Practice Address - Country:US
Practice Address - Phone:630-748-9407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)