Healthcare Provider Details

I. General information

NPI: 1104213818
Provider Name (Legal Business Name): SOUTHCENTRALTRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E LINCOLN ST
CEYLON MN
56121-4033
US

IV. Provider business mailing address

102 E LINCOLN ST PO BOX 54
CEYLON MN
56121-4033
US

V. Phone/Fax

Practice location:
  • Phone: 507-848-3129
  • Fax: 507-632-4273
Mailing address:
  • Phone: 507-848-3129
  • Fax: 507-632-4273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MRS. TYAN MARIE BREDE
Title or Position: OWNER
Credential:
Phone: 507-848-3129