Provider Demographics
NPI:1821446857
Name:MUGO, FRANCIS
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:MUGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BODWELL AVE
Mailing Address - Street 2:D/B/A ANNEX TRANSIT LLC
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2403
Mailing Address - Country:US
Mailing Address - Phone:978-996-2146
Mailing Address - Fax:
Practice Address - Street 1:18 BODWELL AVE
Practice Address - Street 2:D/B/A ANNEX TRANSIT LLC
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2403
Practice Address - Country:US
Practice Address - Phone:978-996-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001214919343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0627Medicare PIN