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NPI Code Detail

MEDICARE: SOUTHSIDE TRANSPORTATION LLC

MEDICARE: SOUTHSIDE 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
1343900000XNon-emergency Medical Transport (VAN)

General Provider Information

NPI Number : 1336607233
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHSIDE TRANSPORTATION LLC
Provider Business Mailing Address
First Line : 117 COLE CT
Second Line :
City : MANKATO
State : MN
Zip : 56001-6426
Country : US
Telephone Number : 507-351-4212
Fax Number :
Provider Business Practice Location Address
First Line : 2940 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1322
Country : US
Telephone Number : 507-351-4212
Fax Number :
Authorized Official
Title or Position : CEO/PRESIDENT
Name : ASHA BUSURI
Credential :
Telephone Number : 507-351-4212
Provider Enumeration Date : 03/09/2019
Last Update Date : 03/09/2019

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Directions to “SOUTHSIDE TRANSPORTATION LLC ” Practice Location

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