Provider Demographics
NPI:1114718988
Name:MEDINAH TRANSPORT LLC
Entity type:Organization
Organization Name:MEDINAH TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YASIR
Authorized Official - Middle Name:YUSUF
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-489-7101
Mailing Address - Street 1:2033 VINE ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-3849
Mailing Address - Country:US
Mailing Address - Phone:920-489-7101
Mailing Address - Fax:
Practice Address - Street 1:2033 VINE ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-3849
Practice Address - Country:US
Practice Address - Phone:920-489-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)