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General NPI Number Information
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NPI Number | 1750707436
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Entity Type | Organization
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Legal Business Name | IRIDE INC.
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Dates
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Enumeration Date | 03/05/2014
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Last Update Date | 05/28/2015
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Provider Practice Location Address
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Address Line | 17678 72ND AVE N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-2742
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Country | US
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Telephone | 763-220-0024
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Fax | 813-501-1131
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Provider Business Mailing Address
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Address Line | 17678 72ND AVE N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-2742
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Country | US
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Telephone | 763-220-0024
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Fax | 813-501-1131
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Authorized Official
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Title or Position | CEO
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Name | MR. IVAN MURAVEYNIK
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Credential |
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Telephone | 763-220-0024
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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 | MN
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