Provider Demographics
NPI:1952042418
Name:VIP TRANSPORTATION
Entity Type:Organization
Organization Name:VIP TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIRISAK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-290-4178
Mailing Address - Street 1:2845 PASCAL ST APT 11G
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1787
Mailing Address - Country:US
Mailing Address - Phone:763-290-4178
Mailing Address - Fax:
Practice Address - Street 1:2845 PASCAL ST APT 11G
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1787
Practice Address - Country:US
Practice Address - Phone:763-290-4178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)