MEDICARE: EXPRESS TRANSPORTATION INC

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)

General Provider Information

NPI Number	:	1265950760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXPRESS TRANSPORTATION INC

Provider Business Mailing Address
First Line	:	PO BOX 29331
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55429-0331
Country	:	US
Telephone Number	:	612-205-3535
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 58 1/2 AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55429-3042
Country	:	US
Telephone Number	:	612-205-3535
Fax Number	:	612-205-3535

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	JAMAL SAID
Credential	:
Telephone Number	:	612-205-3535

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	09/05/2017

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