Midwest Medivan, Inc

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Legal business name

MIDWEST MEDIVAN, INC

Doing business as

Forest City Cab

Practice address

535 Loves Park Dr
Loves Park, IL 61111-5179

Phone

(815) 977-7552

Fax

(815) 977-7007

NPI assigned

Nov 19, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Nickolas Jupin

Title

President/Ceo

Phone

(815) 977-7552

Specialties & licenses 1

Addresses

Other names 1

• Forest City Cab Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1290124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459036800000",
    "number": "1245532530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 LOVES PARK DR",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611115179",
            "telephone_number": "815-977-7552",
            "fax_number": "815-977-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 LOVES PARK DR",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611115179",
            "telephone_number": "815-977-7552",
            "fax_number": "815-977-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST MEDIVAN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-19",
        "last_updated": "2016-03-27",
        "status": "A",
        "authorized_official_last_name": "JUPIN",
        "authorized_official_first_name": "NICKOLAS",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "815-977-7552",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forest City Cab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Non-emergency Medical Transport (VAN) in Loves Park, IL
• Providers in Loves Park, IL by specialty
• Non-emergency Medical Transport (VAN) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.