Provider Demographics
NPI:1982069134
Name:MIDWEST MEDICAL TRANSPORT COMPANY LLC
Entity type:Organization
Organization Name:MIDWEST MEDICAL TRANSPORT COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-800-2934
Mailing Address - Street 1:2155 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3148
Mailing Address - Country:US
Mailing Address - Phone:402-562-6430
Mailing Address - Fax:
Practice Address - Street 1:705 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:IA
Practice Address - Zip Code:50025-1316
Practice Address - Country:US
Practice Address - Phone:712-269-6134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST MEDICAL TRANSPORT COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5158341600000X, 3416A0800X, 3416L0300X
IA2001400341600000X, 3416A0800X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416A0800XTransportation ServicesAmbulanceAir Transport
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026491400Medicaid
IA1871991125Medicaid
IA1871991125Medicaid
NE10026491400Medicaid