MEDICARE: LEE'S NEMT L.L.C

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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1790504405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE'S NEMT L.L.C

Provider Business Mailing Address
First Line	:	2301 N UPLAND CRST
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-2036
Country	:	US
Telephone Number	:	559-362-8813
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 N UPLAND CRST
Second Line	:
City	:	COLUMBIA HEIGHTS
State	:	MN
Zip	:	55421-2036
Country	:	US
Telephone Number	:	559-362-8813
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDDIE MOUA
Credential	:
Telephone Number	:	559-362-8813

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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Directions to “LEE'S NEMT L.L.C ” Practice Location

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