MEDICARE: DISTINCT 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	343900000X	Non-emergency Medical Transport (VAN)		MN

General Provider Information

NPI Number	:	1245697937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISTINCT TRANSPORTATION SERVICES

Provider Business Mailing Address
First Line	:	1725 7TH ST S
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-4047
Country	:	US
Telephone Number	:	612-503-4200
Fax Number	:	612-503-4200

Provider Business Practice Location Address
First Line	:	1725 7TH ST S
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-4047
Country	:	US
Telephone Number	:	612-503-4200
Fax Number	:	612-503-4200

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ABDIRAHMAN HUSSEIN FURRE
Credential	:
Telephone Number	:	612-503-4200

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	02/16/2016

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