MEDICARE: ICARE 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1487012548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICARE TRANSPORTATION

Provider Business Mailing Address
First Line	:	2816 SILVER LN NE APT 305
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55421-3483
Country	:	US
Telephone Number	:	763-291-8345
Fax Number	:

Provider Business Practice Location Address
First Line	:	2816 SILVER LN NE #305
Second Line	:
City	:	SAINT ANTHONY
State	:	MN
Zip	:	55421
Country	:	US
Telephone Number	:	763-291-8345
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MUUMIN M CAWAALE
Credential	:
Telephone Number	:	763-291-8345

Provider Enumeration Date	:	02/04/2016
Last Update Date	:	02/04/2016

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Directions to “ICARE TRANSPORTATION ” Practice Location

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