Provider Demographics
NPI:1053585877
Name:EAST CENTRAL ILLINOIS MASS TRANSIT
Entity type:Organization
Organization Name:EAST CENTRAL ILLINOIS MASS TRANSIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-465-8143
Mailing Address - Street 1:256 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-1721
Mailing Address - Country:US
Mailing Address - Phone:217-466-6921
Mailing Address - Fax:217-466-6921
Practice Address - Street 1:256 W COURT ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-1721
Practice Address - Country:US
Practice Address - Phone:217-466-6921
Practice Address - Fax:217-466-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2127MC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid