MEDICARE: MEDSTAR 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)

General Provider Information

NPI Number	:	1841053717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSTAR TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	3834 BEAR RIDGE AVE S
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-6244
Country	:	US
Telephone Number	:	507-213-3647
Fax Number	:

Provider Business Practice Location Address
First Line	:	3834 BEAR RIDGE AVE S
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-6244
Country	:	US
Telephone Number	:	507-213-3647
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABDIRISAQ NUR HASSAN
Credential	:
Telephone Number	:	507-213-3647

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/02/2024

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Directions to “MEDSTAR TRANSPORTATION LLC ” Practice Location

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