Provider Demographics
NPI:1538359211
Name:MINNESOTA TRANSPORTATION SERVICES LLC
Entity type:Organization
Organization Name:MINNESOTA TRANSPORTATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:THAI
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-757-8296
Mailing Address - Street 1:1001 JOHNSON PARKWAY
Mailing Address - Street 2:SUITE #127
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106
Mailing Address - Country:US
Mailing Address - Phone:651-414-0083
Mailing Address - Fax:651-414-9989
Practice Address - Street 1:1001 JOHNSON PARKWAY
Practice Address - Street 2:SUITE #127
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106
Practice Address - Country:US
Practice Address - Phone:651-414-0083
Practice Address - Fax:651-414-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1958427-2343900000X, 347C00000X, 261QA0600X
MNBY74451261QA0600X, 347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN345G3MEOtherBLUE CROSS BLUE SHIELD