Provider Demographics
NPI:1528519626
Name:MIDMINN TRANSPORT LLC
Entity type:Organization
Organization Name:MIDMINN TRANSPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERVAN
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:CHRISTOPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-250-0499
Mailing Address - Street 1:4393 165TH AVE
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-9450
Mailing Address - Country:US
Mailing Address - Phone:320-250-0499
Mailing Address - Fax:763-261-5576
Practice Address - Street 1:4393 165TH AVE
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-9450
Practice Address - Country:US
Practice Address - Phone:320-250-0499
Practice Address - Fax:763-261-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4724376343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)