Basic Information
| Provider Information | |||||||||
| NPI: | 1568493021 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROFESSIONAL MEDICAL TRANSPORTATION SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 457 | ||||||||
| Address2: | |||||||||
| City: | WHEELING | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600900457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475778811 | ||||||||
| FaxNumber: | 8475777967 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 W COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600041962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472599675 | ||||||||
| FaxNumber: | 8479638703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LAZZERINI | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8472599675 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 8958 | IL | X | Transportation Services | Ambulance | Land Transport | 343900000X | 8958 | IL | X | Transportation Services | Non-emergency Medical Transport (VAN) |
ID Information
| ID | Type | State | Issuer | Description | 01635699 | 01 | IL | BCBS | OTHER | P00285632 | 01 | IL | RR MEDICARE | OTHER |