Provider Demographics
NPI:1720833759
Name:EVIDENT TRANSPORT LLC
Entity Type:Organization
Organization Name:EVIDENT TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOU-BAYONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-300-0140
Mailing Address - Street 1:7300 HUDSON BLVD N STE 185
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-7146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7300 HUDSON BLVD N STE 185
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-7146
Practice Address - Country:US
Practice Address - Phone:651-300-0140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center