Provider Demographics
NPI:1013296029
Name:TALO TRANSPORT (T.T.) INC.
Entity type:Organization
Organization Name:TALO TRANSPORT (T.T.) INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAHIR
Authorized Official - Middle Name:MIRREH
Authorized Official - Last Name:JIBREEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-355-2811
Mailing Address - Street 1:1806 RIVERSIDE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:612-338-5917
Practice Address - Street 1:1806 RIVERSIDE AVE STE 3
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1035
Practice Address - Country:US
Practice Address - Phone:763-355-2811
Practice Address - Fax:612-338-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN376358Medicaid