Provider Demographics
NPI:1154864254
Name:SELECT TRANSPORTATION
Entity type:Organization
Organization Name:SELECT TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-267-5999
Mailing Address - Street 1:12631 FREMONT AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-7100
Mailing Address - Country:US
Mailing Address - Phone:763-267-5999
Mailing Address - Fax:763-856-5734
Practice Address - Street 1:12631 FREMONT AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-7100
Practice Address - Country:US
Practice Address - Phone:763-267-5999
Practice Address - Fax:763-856-5734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNT200286239002343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)