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General NPI Number Information
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NPI Number | 1174488217
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Entity Type | Organization
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Legal Business Name | STRAIGHT RIVER MED VAN
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 770 25TH ST NE
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City | OWATONNA
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State | MN
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Zip | 55060-2482
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Country | US
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Telephone | 507-363-5552
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Fax | 507-363-5552
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Provider Business Mailing Address
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Address Line | 770 25TH ST NE
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City | OWATONNA
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State | MN
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Zip | 55060-2482
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Country | US
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Telephone | 507-363-5552
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Fax | 507-363-5552
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Authorized Official
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Title or Position | OWNER
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Name | RAPHAEL JEAN LIESKE
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Credential |
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Telephone | 507-363-5552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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