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General NPI Number Information
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NPI Number | 1578288924
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Entity Type | Organization
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Legal Business Name | GOLDEN MEDICAL TRANSPORTATION LLC
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Dates
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Enumeration Date | 10/07/2022
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 1740 E MASON ST # 5
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City | GREEN BAY
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State | WI
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Zip | 54302-3258
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Country | US
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Telephone | 920-930-9201
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Fax |
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Provider Business Mailing Address
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Address Line | 2413 SYCAMORE DR APT 5
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City | GREEN BAY
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State | WI
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Zip | 54311-5146
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Country | US
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Telephone | 920-930-9201
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Fax |
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Authorized Official
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Title or Position | OWNER-MANAGER
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Name | RAHMO MOHAMED KASSIM
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Credential |
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Telephone | 920-930-9201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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