Provider Demographics
NPI:1770387532
Name:STATE EXPRESS MOBILITY LLC
Entity type:Organization
Organization Name:STATE EXPRESS MOBILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DRIVER
Authorized Official - Prefix:
Authorized Official - First Name:SAMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-334-8981
Mailing Address - Street 1:5401 94TH AVE N UNIT 104
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-5501
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5401 94TH AVE N UNIT 104
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-5501
Practice Address - Country:US
Practice Address - Phone:763-496-4189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)