=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245956606
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AHMAD ALI MAHMOUD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2022
-----------------------------------------------------
Last Update Date | 10/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2540 E RIVER RD NE
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55906-3448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-319-1773
-----------------------------------------------------
Fax | 507-206-4733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2540 E RIVER RD NE
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55906-3448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-319-1773
-----------------------------------------------------
Fax | 507-206-4733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------