MEDICARE: J&M MOBILITY 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	:	1770220303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J&M MOBILITY TRANSPORTATION,LLC

Provider Business Mailing Address
First Line	:	1849 LACHMAN AVE NE
Second Line	:
City	:	SAINT MICHAEL
State	:	MN
Zip	:	55376-4226
Country	:	US
Telephone Number	:	763-225-7290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1849 LACHMAN AVE NE
Second Line	:
City	:	SAINT MICHAEL
State	:	MN
Zip	:	55376-4226
Country	:	US
Telephone Number	:	763-225-7290
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. SIMON TSE AKUNDU SR.
Credential	:
Telephone Number	:	763-225-7290

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	11/07/2022

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