Provider Demographics
NPI:1346080231
Name:MIDAL TRANSPORTATION LLC
Entity type:Organization
Organization Name:MIDAL TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ DISPATCHER
Authorized Official - Prefix:
Authorized Official - First Name:DAGMAWI
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:971-337-5310
Mailing Address - Street 1:10590 SE CHERRY BLOSSOM DR APT 59
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2851
Mailing Address - Country:US
Mailing Address - Phone:971-337-5310
Mailing Address - Fax:
Practice Address - Street 1:10590 SE CHERRY BLOSSOM DR APT 59
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2851
Practice Address - Country:US
Practice Address - Phone:971-337-5310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)