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General NPI Number Information
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NPI Number | 1184012148
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Entity Type | Organization
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Legal Business Name | W. PONY EXPRESS LLC
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 1608 E 5TH ST
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City | DULUTH
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State | MN
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Zip | 55812-1203
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Country | US
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Telephone | 218-766-9337
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 E 5TH ST
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City | DULUTH
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State | MN
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Zip | 55812-1203
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Country | US
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Telephone | 218-766-9337
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | KADY HURTIG
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Credential |
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Telephone | 218-766-9337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | STS378972
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License Number State | MN
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