Provider Demographics
NPI:1023356813
Name:OUTREACH TRANSPORTATION SERVICES LLC
Entity Type:Organization
Organization Name:OUTREACH TRANSPORTATION SERVICES LLC
Other - Org Name:OUTREACH TRANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-670-8327
Mailing Address - Street 1:716 COUNTY ROAD 10 NE # 111
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55112-2331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5394 EDGEWOOD DRIVE
Practice Address - Street 2:MOUNDS VIEW COMMUNITY CENTER
Practice Address - City:MOUNDS VIEW
Practice Address - State:MN
Practice Address - Zip Code:55112-1402
Practice Address - Country:US
Practice Address - Phone:763-220-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)