MEDICARE: COHERENT TRANSPORTAION INC

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)	854512500022	MN

General Provider Information

NPI Number	:	1396119095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COHERENT TRANSPORTAION INC

Provider Business Mailing Address
First Line	:	2817 ANTHONY LN S
Second Line	:	SUITE 212
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-3254
Country	:	US
Telephone Number	:	612-810-6216
Fax Number	:

Provider Business Practice Location Address
First Line	:	2817 ANTHONY LN S
Second Line	:	SUITE 212
City	:	ST ANTHONY
State	:	MN
Zip	:	55418-3254
Country	:	US
Telephone Number	:	612-810-6216
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMOUD SAEED MOHAMOUD
Credential	:
Telephone Number	:	612-810-6216

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	11/18/2015

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