Healthcare Provider Details

I. General information

NPI: 1518217538
Provider Name (Legal Business Name): ALLEGIANCE TRANSPORTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2756 EDGERTON ST
LITTLE CANADA MN
55117-1229
US

IV. Provider business mailing address

2756 EDGERTON ST
LITTLE CANADA MN
55117-1229
US

V. Phone/Fax

Practice location:
  • Phone: 651-207-5211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PETER DONOVAN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 612-281-4234