Healthcare Provider Details

I. General information

NPI: 1619800463
Provider Name (Legal Business Name): PATHWAY TRANSPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E ENTERPRISE AVE STE 333
APPLETON WI
54913-7889
US

IV. Provider business mailing address

6700 RICHFIELD PKWY # B104
RICHFIELD MN
55423-7514
US

V. Phone/Fax

Practice location:
  • Phone: 612-246-2337
  • Fax:
Mailing address:
  • Phone: 612-246-2337
  • 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: ABDIKADIR A MOHAMED
Title or Position: OWNER
Credential:
Phone: 612-246-2337