=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871210096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMSA MEDICAL TRANSPORTATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2022
-----------------------------------------------------
Last Update Date | 10/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5906 HICKMAN RD APT 6
-----------------------------------------------------
City | DES MOINES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50322-6039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-229-6619
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4603 121ST AVE NE
-----------------------------------------------------
City | BLAINE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55449-7059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-389-7174
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | KALTUN JAMA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-389-7174
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------