=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437716073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVES TRANSPORT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2019
-----------------------------------------------------
Last Update Date | 05/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 W 5TH ST
-----------------------------------------------------
City | ZUMBROTA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55992-1157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-884-1481
-----------------------------------------------------
Fax | 507-732-7370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 615 W 5TH ST
-----------------------------------------------------
City | ZUMBROTA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55992-1157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-884-1481
-----------------------------------------------------
Fax | 507-732-7370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAVID DANIELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-884-1481
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------