Provider Demographics
NPI:1003276304
Name:MN LAKERS TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:MN LAKERS TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LOGISTICS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:ISMAIL
Authorized Official - Last Name:OSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-205-5116
Mailing Address - Street 1:5701 SHINGLE CREEK PKWY STE 344
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2467
Mailing Address - Country:US
Mailing Address - Phone:763-205-5116
Mailing Address - Fax:763-205-5554
Practice Address - Street 1:1228 30TH ST NW # S319
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-4131
Practice Address - Country:US
Practice Address - Phone:612-483-0374
Practice Address - Fax:763-205-5554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)