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General NPI Number Information
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NPI Number | 1598121279
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Entity Type | Organization
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Legal Business Name | PRIME TRANSPORTATION LLC
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 14274 IRVING AVE S 244
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City | BURNSVILLE
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State | MN
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Zip | 55306-7111
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Country | US
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Telephone | 612-501-4272
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Fax |
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Provider Business Mailing Address
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Address Line | 14274 IRVING AVE S 244
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City | BURNSVILLE
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State | MN
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Zip | 55306-7111
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Country | US
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Telephone | 612-501-4272
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALI MOHAMED MIRE
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Credential |
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Telephone | 612-501-4272
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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 | 865921300030
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License Number State | MN
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