Mohamud Ali Hassan – Driver in Prior Lake, MN

Key facts

NPI: 1194557488
Entity type: Individual (NPI type 1)
Primary specialty: Driver 172A00000X
License: H508-055-980-813 (MN)
Practice address: 15815 Franklin TRL SE Ste 502
Prior Lake, MN 55372-2076
Phone: (612) 205-2030
NPI assigned: Aug 15, 2024
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Mas24 Transport Inc Non-emergency Medical Transport (VAN) · Prior Lake, MN · NPI 1518799725

NPD

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
H508-055-980-813	MN	MD	Driver

Practice roles

Organization	Specialty	Status	New patients
Mas24 Transport Inc		Current since Aug 1, 2024	Accepting new patients

Locations

15815 Franklin Trl SE
Ste 502
Prior Lake, MN 55372
Phone (507) 202-3707

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Driver	172A00000X	H508-055-980-813	MN	Yes

Addresses

Primary practice location

15815 Franklin TRL SE Ste 502
Prior Lake, MN 55372-2076

Mailing address

15815 Franklin TRL SE Ste 502
Prior Lake, MN 55372-2076
Phone (612) 205-2030

Other providers in Prior Lake, MN

All providers in Prior Lake, MN · Driver in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.