MEDICARE: SAMSAM TRANSPORTATION LLC

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)	TRANSPORATION	MN

General Provider Information

NPI Number	:	1548625155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMSAM TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	1537 12TH AVE SE
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56304-2217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1537 12TH AVE SE
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56304-2217
Country	:	US
Telephone Number	:	320-237-1150
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHUKRI HASHI
Credential	:
Telephone Number	:	320-237-1150

Provider Enumeration Date	:	12/24/2015
Last Update Date	:	12/24/2015

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