Healthcare Provider Details

I. General information

NPI: 1306137617
Provider Name (Legal Business Name): APS PAYROLL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5837 HYLAND COURTS DRIVE #200
MINNEAPOLIS MN
55437-1934
US

IV. Provider business mailing address

5837 HYLAND COURTS DRIVE #200
MINNEAPOLIS MN
55437-1934
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-9580
  • Fax: 952-835-9576
Mailing address:
  • Phone: 952-835-9580
  • Fax: 952-835-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMN

VIII. Authorized Official

Name: RONALD JOHN ANTOINE
Title or Position: PRESIDENT
Credential:
Phone: 952-835-9580