MEDICARE: LEFT LANE TRANSPORTATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	844768300028	MN

General Provider Information

NPI Number	:	1245697614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEFT LANE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	2121 NICOLLET AVE # 206
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2566
Country	:	US
Telephone Number	:	612-205-0723
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 NICOLLET AVE # 206
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2566
Country	:	US
Telephone Number	:	612-205-0723
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KHALID SHARIF
Credential	:
Telephone Number	:	612-205-0723

Provider Enumeration Date	:	01/15/2016
Last Update Date	:	01/15/2016

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