Healthcare Provider Details

I. General information

NPI: 1578314472
Provider Name (Legal Business Name): MSA TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22181 BEVERLY ST
OAK PARK MI
48237-2576
US

IV. Provider business mailing address

22181 BEVERLY ST
OAK PARK MI
48237-2576
US

V. Phone/Fax

Practice location:
  • Phone: 248-238-3086
  • Fax:
Mailing address:
  • Phone: 248-238-3086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MAGUETTE TOURE DIOP
Title or Position: OWNER
Credential:
Phone: 248-238-3086