Healthcare Provider Details

I. General information

NPI: 1538690680
Provider Name (Legal Business Name): ALFASON INCORPORATED DBA RIDEY TAXI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 45TH ST S SUITE 177
FARGO ND
58104-8962
US

IV. Provider business mailing address

3523 45TH ST S SUITE 177
FARGO ND
58104-8962
US

V. Phone/Fax

Practice location:
  • Phone: 701-526-1488
  • Fax:
Mailing address:
  • Phone: 701-526-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number41718800
License Number StateND

VIII. Authorized Official

Name: ANTHONY ALFA
Title or Position: DIRECTOR
Credential:
Phone: 701-805-5888