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General NPI Number Information
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NPI Number | 1598034548
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Entity Type | Organization
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Legal Business Name | NEW VISION TRANSPORTATION L.L.C
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 2441 YOUNGMAN AVE APT 2C
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City | SAINT PAUL
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State | MN
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Zip | 55116-3064
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Country | US
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Telephone | 651-354-1770
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Fax |
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Provider Business Mailing Address
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Address Line | 2441 YOUNGMAN AVE APT 2C APT 2C
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City | SAINT PAUL
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State | MN
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Zip | 55116-3043
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Country | US
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Telephone | 651-354-1770
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Fax |
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Authorized Official
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Title or Position | OWNER OR MANAGER
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Name | MR. EDAO HAWIYA BUKULA
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Credential |
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Telephone | 651-354-1770
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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 | 376376
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License Number State | MN
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