Healthcare Provider Details

I. General information

NPI: 1265664130
Provider Name (Legal Business Name): LINCOLN COUNTY HEARTLAND EXPRESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 N REBECCA ST # 29
IVANHOE MN
56142-9572
US

IV. Provider business mailing address

319 N REBECCA ST P.O. BOX 33
IVANHOE MN
56142-9572
US

V. Phone/Fax

Practice location:
  • Phone: 507-694-1813
  • Fax:
Mailing address:
  • Phone: 507-694-1813
  • Fax: 507-694-1198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347B00000X
TaxonomyBus
License Number347B00000X
License Number StateMN

VIII. Authorized Official

Name: MRS. CARA L NIELSEN
Title or Position: TRANSIT DIRECTOR
Credential:
Phone: 507-694-1813