Provider Demographics
NPI:1013207000
Name:MIDWEST MOBILITY SERVICES LLC
Entity Type:Organization
Organization Name:MIDWEST MOBILITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEXINGTON
Authorized Official - Middle Name:MUTHAMA
Authorized Official - Last Name:NDUULU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-363-4389
Mailing Address - Street 1:2645 1ST AVE S STE B01
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1806
Mailing Address - Country:US
Mailing Address - Phone:612-767-7788
Mailing Address - Fax:612-767-7789
Practice Address - Street 1:2645 1ST AVE S STE B01
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1806
Practice Address - Country:US
Practice Address - Phone:612-767-7788
Practice Address - Fax:612-767-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376132343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN376132OtherSTS