MEDICARE: MEDIGO 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)

General Provider Information

NPI Number	:	1366121816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIGO TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	2958 VANDERBIE ST
Second Line	:
City	:	LITTLE CANADA
State	:	MN
Zip	:	55117-1225
Country	:	US
Telephone Number	:	206-468-4882
Fax Number	:

Provider Business Practice Location Address
First Line	:	2958 VANDERBIE ST
Second Line	:
City	:	LITTLE CANADA
State	:	MN
Zip	:	55117-1225
Country	:	US
Telephone Number	:	206-468-4882
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ILHAM MOHAMED
Credential	:
Telephone Number	:	651-208-9604

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	07/12/2023

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Directions to “MEDIGO TRANSPORTATION LLC ” Practice Location

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