Provider Demographics
NPI:1023879871
Name:MEDTRANSPORT-512 LLC
Entity type:Organization
Organization Name:MEDTRANSPORT-512 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:HUSSAIN
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-612-3688
Mailing Address - Street 1:105 S 38TH ST APT 191
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3385
Mailing Address - Country:US
Mailing Address - Phone:402-612-3688
Mailing Address - Fax:
Practice Address - Street 1:105 S 38TH ST APT 191
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3385
Practice Address - Country:US
Practice Address - Phone:402-612-3688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)