Healthcare Provider Details

I. General information

NPI: 1871816025
Provider Name (Legal Business Name): CITY CAB & VAN SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 9TH ST
INTERNATIONAL FALLS MN
56649-2747
US

IV. Provider business mailing address

200 9TH ST
INTERNATIONAL FALLS MN
56649-2747
US

V. Phone/Fax

Practice location:
  • Phone: 218-283-8635
  • Fax: 218-283-3958
Mailing address:
  • Phone: 218-283-8635
  • Fax: 218-283-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number1
License Number StateMN

VIII. Authorized Official

Name: JOSEPH F BLACK
Title or Position: OWNER
Credential:
Phone: 218-283-8635