Provider Demographics
NPI:1942678164
Name:WELLMARK NON-EMERGENCY TRANSPORTATION LLC
Entity Type:Organization
Organization Name:WELLMARK NON-EMERGENCY TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:MOKEIRA
Authorized Official - Last Name:OSEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-744-6244
Mailing Address - Street 1:801 E RIVER RD
Mailing Address - Street 2:# 217
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2800
Mailing Address - Country:US
Mailing Address - Phone:763-744-6244
Mailing Address - Fax:
Practice Address - Street 1:801 E RIVER RD
Practice Address - Street 2:# 217
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2800
Practice Address - Country:US
Practice Address - Phone:763-744-6244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)