Healthcare Provider Details

I. General information

NPI: 1821364613
Provider Name (Legal Business Name): SONNY'S TAXI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 N HAMPTON ST
FAIRMONT MN
56031-3714
US

IV. Provider business mailing address

1009 N HAMPTON ST
FAIRMONT MN
56031-3714
US

V. Phone/Fax

Practice location:
  • Phone: 507-848-0432
  • Fax:
Mailing address:
  • Phone: 507-848-0432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. CORRINE E WALKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 507-235-5237