Healthcare Provider Details

I. General information

NPI: 1346561081
Provider Name (Legal Business Name): MINNESOTA TRANSIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15305 IODINE ST NW
RAMSEY MN
55303-5719
US

IV. Provider business mailing address

15305 IODINE ST NW
RAMSEY MN
55303-5719
US

V. Phone/Fax

Practice location:
  • Phone: 866-859-6160
  • Fax:
Mailing address:
  • Phone: 866-859-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number375739
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number375739
License Number StateMN

VIII. Authorized Official

Name: MR. ANTON KLOCHKO
Title or Position: PARTNER
Credential:
Phone: 866-859-6160