Vendor/Subcontractor Enrollment

If your Company is interested in becoming a Sub-Contractor of a NATIONWIDE TRANSPORTATION NETWORK, please complete the form below. Once the information is received we will review the information and one of representatives will contact you.

Thank you for your participation and we look forward to doing Business with you.

 

Company Name (required)

Address:

City: State: Zip:

Phone:

Contact Name/Title:

Services Provided AIR AMBULANCEALS AMBULANCEBLS AMBULANCEWHEELCHAIR VANSTRETCHER VANSTATION CARTAXILIMOSINEOTHER (Describe below)

Describe Service Area:

General Rate Information:
Med-Van Contracts with a large number of agencies. We ensure all of the agencies that utilize our service a cost effective portal for scheduling transportation. We ask our providers to submit a FEE Schedule and we will work with you to ensure that your organization receives a competitive re-imbursement schedule.

Hours of Operation:
Please provide hours of operation as well as any additional phone numbers needed to schedule transportation "after hours".

Scheduling Software:

Med-Van has developed a DISPATCH / BILLING Software. The Software is very unique for this market and has large number of functions. If interested in the software please indicate below and you will be sent an e-mail to access a DEMO Version of the Software. Our Software is broken down into several different modules, Billing / Dispatch, Inventory Control, Benefits Management, and Vehicle Maintenance. One SOFTWARE to cover all your companies needs.

Thank you!

Your Email (required)

Subject

Your Message

Please check below to prove you're not a robot (required):