Provider Demographics
NPI:1316609472
Name:DISPATCH MEDICAL TRANSPORT
Entity type:Organization
Organization Name:DISPATCH MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-416-5023
Mailing Address - Street 1:3719 CURRAN RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62670-6851
Mailing Address - Country:US
Mailing Address - Phone:217-416-5032
Mailing Address - Fax:
Practice Address - Street 1:3719 CURRAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:IL
Practice Address - Zip Code:62670-6851
Practice Address - Country:US
Practice Address - Phone:217-416-5032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)