Healthcare Provider Details

I. General information

NPI: 1619246220
Provider Name (Legal Business Name): TRANSEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 4TH AVE S SUITE 206
MOORHEAD MN
56560
US

IV. Provider business mailing address

810 4TH AVE S SUITE 206
MOORHEAD MN
56560
US

V. Phone/Fax

Practice location:
  • Phone: 218-233-7438
  • Fax:
Mailing address:
  • Phone: 218-233-7438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE H BRINK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 701-318-1383