Healthcare Provider Details

I. General information

NPI: 1194542522
Provider Name (Legal Business Name): FRONTLINE MOBILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 QUEBEC AVE N STE 104
NEW HOPE MN
55427-1200
US

IV. Provider business mailing address

1555 QUARRY RD APT 427
EAGAN MN
55121-3528
US

V. Phone/Fax

Practice location:
  • Phone: 612-423-9524
  • Fax:
Mailing address:
  • Phone: 612-423-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED SHEIKH
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 612-423-9524