Provider Demographics
NPI:1841053717
Name:MEDSTAR TRANSPORTATION LLC
Entity type:Organization
Organization Name:MEDSTAR TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIRISAQ
Authorized Official - Middle Name:NUR
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-213-3647
Mailing Address - Street 1:3834 BEAR RIDGE AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-6244
Mailing Address - Country:US
Mailing Address - Phone:507-213-3647
Mailing Address - Fax:
Practice Address - Street 1:3834 BEAR RIDGE AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-6244
Practice Address - Country:US
Practice Address - Phone:507-213-3647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)