Healthcare Provider Details

I. General information

NPI: 1548625155
Provider Name (Legal Business Name): SAMSAM TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2015
Last Update Date: 12/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 12TH AVE SE
SAINT CLOUD MN
56304-2217
US

IV. Provider business mailing address

1537 12TH AVE SE
SAINT CLOUD MN
56304-2217
US

V. Phone/Fax

Practice location:
  • Phone: 320-237-1150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHUKRI HASHI
Title or Position: OWNER
Credential:
Phone: 320-237-1150