Provider Demographics
NPI:1740882703
Name:MC TRANSPORTATION SERVICES LLC
Entity type:Organization
Organization Name:MC TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAKSHUMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-410-1000
Mailing Address - Street 1:10026 UNIVERSITY AVE NW STE 212
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-2215
Mailing Address - Country:US
Mailing Address - Phone:651-410-1000
Mailing Address - Fax:612-814-3823
Practice Address - Street 1:10026 UNIVERSITY AVE NW STE 212
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-2215
Practice Address - Country:US
Practice Address - Phone:651-410-1000
Practice Address - Fax:763-780-6958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)