Provider Demographics
NPI:1407201031
Name:PURE MEDICAL TRANSPORTATION
Entity Type:Organization
Organization Name:PURE MEDICAL TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMEDO
Authorized Official - Middle Name:KAMAL
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:RESPIRATORY THERAPIS
Authorized Official - Phone:952-297-7855
Mailing Address - Street 1:9201 GARLAND LN N APT 132
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1341
Mailing Address - Country:US
Mailing Address - Phone:952-297-7855
Mailing Address - Fax:
Practice Address - Street 1:9201 GARLAND LN N APT 132
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-1341
Practice Address - Country:US
Practice Address - Phone:952-297-7855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)