MEDICARE: TRANSIT ONE 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)	94617465	MN

General Provider Information

NPI Number	:	1487091955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSIT ONE TRANSPORTATION LLC

Provider Business Mailing Address
First Line	:	1317 15TH AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3112
Country	:	US
Telephone Number	:	612-501-2861
Fax Number	:	612-529-4733

Provider Business Practice Location Address
First Line	:	1317 15TH AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3112
Country	:	US
Telephone Number	:	612-501-2861
Fax Number	:	612-529-4733

Authorized Official
Title or Position	:	CEO
Name	:	LAISANEE LOR
Credential	:
Telephone Number	:	612-501-2861

Provider Enumeration Date	:	05/23/2013
Last Update Date	:	05/23/2013

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