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General NPI Number Information
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NPI Number | 1790142883
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Entity Type | Organization
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Legal Business Name | STATEWIDE MEDICAL TRANSPORTATION
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 44 28TH AVE N 107E
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City | SAINT CLOUD
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State | MN
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Zip | 56303-4588
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Country | US
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Telephone | 320-420-6587
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 853
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City | SAINT CLOUD
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State | MN
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Zip | 56302-0853
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Country | US
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Telephone | 320-420-6587
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. OSMAN GURE
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Credential |
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Telephone | 320-420-6587
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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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