=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841069408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MO EXPRESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/25/2023
-----------------------------------------------------
Last Update Date | 01/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325 33RD AVE N
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56303-3041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-217-2630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1060 7TH ST SE APT 304
-----------------------------------------------------
City | SAINT CLOUD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56304-1558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-333-0049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MOHAMED SALAT ALI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 320-333-0049
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 342000000X
-----------------------------------------------------
Taxonomy Name | Transportation Network Company
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------