MEDICARE: SOUTHWEST TRANSPORTATION

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	344600000X	Taxi	D374074663414	MN
2	343900000X	Non-emergency Medical Transport (VAN)	D374074663414	MN

General Provider Information

NPI Number	:	1477928190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST TRANSPORTATION

Provider Business Mailing Address
First Line	:	1234 43 1/2 AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3021
Country	:	US
Telephone Number	:	612-868-3902
Fax Number	:

Provider Business Practice Location Address
First Line	:	1234 43 1/2 AVE NE
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-3021
Country	:	US
Telephone Number	:	612-868-3902
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. OMAR M ADOW
Credential	:
Telephone Number	:	612-968-3902

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	12/07/2015

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Directions to “SOUTHWEST TRANSPORTATION ” Practice Location

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