Healthcare Provider Details

I. General information

NPI: 1275369415
Provider Name (Legal Business Name): IMANI TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 GAS LIGHT RD SW
CEDAR RAPIDS IA
52404-7049
US

IV. Provider business mailing address

320 GAS LIGHT RD SW
CEDAR RAPIDS IA
52404-7049
US

V. Phone/Fax

Practice location:
  • Phone: 465-300-1405
  • Fax:
Mailing address:
  • Phone: 465-300-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TREVIS LUMBU KALUNGA
Title or Position: MANAGER GENERAL
Credential:
Phone: 319-693-7990