MEDICARE: APS PAYROLL SERVICE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	171WV0202X	Vehicle Modifications Contractor	MN
2	172A00000X	Driver	MN
3	347C00000X	Private Vehicle	MN
4	332B00000X	Durable Medical Equipment & Medical Supplies	MN

General Provider Information

NPI Number	:	1306137617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APS PAYROLL SERVICE INC

Provider Business Mailing Address
First Line	:	5837 HYLAND COURTS DRIVE
Second Line	:	#200
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55437-1934
Country	:	US
Telephone Number	:	952-835-9580
Fax Number	:	952-835-9576

Provider Business Practice Location Address
First Line	:	5837 HYLAND COURTS DRIVE
Second Line	:	#200
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55437-1934
Country	:	US
Telephone Number	:	952-835-9580
Fax Number	:	952-835-9576

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONALD JOHN ANTOINE
Credential	:
Telephone Number	:	952-835-9580

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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