Healthcare Provider Details

I. General information

NPI: 1407201031
Provider Name (Legal Business Name): PURE MEDICAL TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 GARLAND LN N APT 132
MAPLE GROVE MN
55311-1341
US

IV. Provider business mailing address

9201 GARLAND LN N APT 132
MAPLE GROVE MN
55311-1341
US

V. Phone/Fax

Practice location:
  • Phone: 952-297-7855
  • Fax:
Mailing address:
  • Phone: 952-297-7855
  • 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: AHMEDO KAMAL MOHAMMED
Title or Position: OWNER
Credential: RESPIRATORY THERAPIS
Phone: 952-297-7855