Healthcare Provider Details

I. General information

NPI: 1063751907
Provider Name (Legal Business Name): L F TAXI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12897 HIGHWAY 27
LITTLE FALLS MN
56345-5209
US

IV. Provider business mailing address

12897 HIGHWAY 27
LITTLE FALLS MN
56345-5209
US

V. Phone/Fax

Practice location:
  • Phone: 320-632-9271
  • Fax: 320-632-3756
Mailing address:
  • Phone: 320-632-9271
  • Fax: 320-632-3756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number2012-601
License Number StateMN

VIII. Authorized Official

Name: MR. RAYMOND JOHN VANHERCKE JR.
Title or Position: PRESIDENT
Credential:
Phone: 320-632-9271