Fomak Transportation,LLC

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Legal business name

FOMAK TRANSPORTATION,LLC

Practice address

1352 Whipple CT
North Liberty, IA 52317-4841

Phone

(319) 270-1197

NPI assigned

Mar 20, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. David Mahioka Mbambukulu

Title

Owner

Phone

(319) 270-1197

Specialties & licenses 1

Addresses

Other names 1

• Fomak Transportation,llc Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1710892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1104686955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1352 WHIPPLE CT",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "523174841",
            "telephone_number": "319-621-8577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1352 WHIPPLE CT",
            "city": "NORTH LIBERTY",
            "state": "IA",
            "postal_code": "523174841",
            "telephone_number": "319-270-1197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOMAK TRANSPORTATION,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-20",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "MAHIOKA MBAMBUKULU",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "319-270-1197",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fomak Transportation,llc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.