Healthcare Provider Details

I. General information

NPI: 1114208097
Provider Name (Legal Business Name): AIRPORT EXPRESS SUPER TAXI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE W SUITE S-318
SAINT PAUL MN
55104-2801
US

IV. Provider business mailing address

1821 UNIVERSITY AVE W SUITE S-318
SAINT PAUL MN
55104-2801
US

V. Phone/Fax

Practice location:
  • Phone: 612-349-9999
  • Fax:
Mailing address:
  • Phone: 612-349-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License NumberL256 50026
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberL256 50026
License Number StateMN

VIII. Authorized Official

Name: MR. AWALE TAHIRO
Title or Position: BUSINESS OWNER
Credential:
Phone: 651-203-3402