MEDICARE: SHYNE BRIGHT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	305S00000X	Point of Service
2	343900000X	Non-emergency Medical Transport (VAN)
3	347E00000X	Transportation Broker
4	347C00000X	Private Vehicle

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184275000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHYNE BRIGHT SERVICES LLC

Provider Business Mailing Address
First Line	:	1611 E 32ND ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1828
Country	:	US
Telephone Number	:	651-795-9256
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 E 32ND ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1828
Country	:	US
Telephone Number	:	651-795-9256
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES EDWARD CLAYTON
Credential	:
Telephone Number	:	651-795-9256

Provider Enumeration Date	:	09/23/2019
Last Update Date	:	09/23/2019

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