Provider Demographics
NPI:1760255384
Name:MIMITOM TRANSPORTATION LLC
Entity Type:Organization
Organization Name:MIMITOM TRANSPORTATION LLC
Other - Org Name:MIMITOM TRANSPORTATION LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MULUKEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKENEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-762-0792
Mailing Address - Street 1:1400 LITTLE ELM TRL UNIT 1307
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2864
Mailing Address - Country:US
Mailing Address - Phone:512-762-0792
Mailing Address - Fax:
Practice Address - Street 1:1400 LITTLE ELM TRL UNIT 1307
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2864
Practice Address - Country:US
Practice Address - Phone:512-762-0792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)