=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518788702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EZ TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2024
-----------------------------------------------------
Last Update Date | 10/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 LABORE RD APT 204
-----------------------------------------------------
City | LITTLE CANADA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55117-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-528-4924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 LABORE RD APT 204
-----------------------------------------------------
City | LITTLE CANADA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55117-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-528-4924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/OWNER
-----------------------------------------------------
Name | ABDIFATAH SHEIKHDON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 651-528-4924
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------