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General NPI Number Information
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NPI Number | 1629503206
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Entity Type | Organization
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Legal Business Name | RIVER SOURCE TRANSPORTATION
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 7800 METRO PKWY #300
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1514
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Country | US
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Telephone | 952-223-3773
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Fax | 952-955-4395
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Provider Business Mailing Address
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Address Line | 7800 METRO PKWY #300
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1514
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Country | US
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Telephone | 952-223-3773
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Fax | 952-955-4395
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Authorized Official
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Title or Position | MANAGER
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Name | VICTOR OWUSU ABABIO
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Credential | MANAGER
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Telephone | 952-223-3773
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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 | 382309
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License Number State | MN
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