MEDICARE: MNSTATE TRANSPORTATION SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	342000000X	Transportation Network Company

General Provider Information

NPI Number	:	1053149344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MNSTATE TRANSPORTATION SERVICES

Provider Business Mailing Address
First Line	:	2833 13TH AVE S STE 255
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2833 13TH AVE S STE 255
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1417
Country	:	US
Telephone Number	:	612-800-2447
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ABDIRAHMAN DHEEG
Credential	:
Telephone Number	:	612-800-2447

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	07/26/2024

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