Provider Demographics
NPI:1427633296
Name:DARRELL AND PENNY BOHLMAN
Entity type:Organization
Organization Name:DARRELL AND PENNY BOHLMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:BOHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-556-0282
Mailing Address - Street 1:49812 169TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601
Mailing Address - Country:US
Mailing Address - Phone:218-556-0282
Mailing Address - Fax:218-854-4080
Practice Address - Street 1:49812 169TH AVE
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601
Practice Address - Country:US
Practice Address - Phone:218-556-0282
Practice Address - Fax:218-854-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-13
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)