Healthcare Provider Details

I. General information

NPI: 1386980282
Provider Name (Legal Business Name): EAST CENTRAL TRANSPORATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2012
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 301ST AVE NE
ISANTI MN
55040-6120
US

IV. Provider business mailing address

1698 301ST AVE NE
ISANTI MN
55040-6120
US

V. Phone/Fax

Practice location:
  • Phone: 763-302-9245
  • Fax:
Mailing address:
  • Phone: 763-302-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License NumberW833251375814
License Number StateMN

VIII. Authorized Official

Name: MR. BRAD KEVIN REICHEL
Title or Position: OWNER
Credential:
Phone: 763-302-9245