Provider Demographics
NPI:1841688413
Name:MIDWEST MEDITRANSPORT
Entity type:Organization
Organization Name:MIDWEST MEDITRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LENARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MAYZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-998-1568
Mailing Address - Street 1:17678 72ND AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2742
Mailing Address - Country:US
Mailing Address - Phone:612-998-1568
Mailing Address - Fax:612-567-0481
Practice Address - Street 1:17678 72ND AVE N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2742
Practice Address - Country:US
Practice Address - Phone:612-998-1568
Practice Address - Fax:612-567-0481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker