Healthcare Provider Details

I. General information

NPI: 1124855572
Provider Name (Legal Business Name): MAGAN TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 HOLTON ST
MEDFORD MA
02155-3513
US

IV. Provider business mailing address

18 HOLTON ST
MEDFORD MA
02155-3513
US

V. Phone/Fax

Practice location:
  • Phone: 617-869-8019
  • Fax: 617-758-7123
Mailing address:
  • Phone: 617-869-8019
  • Fax: 617-758-7123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ABDULLAHI J MAGAN
Title or Position: OWNER
Credential:
Phone: 617-869-8019