Provider Demographics
NPI:1154832806
Name:LEROY CITY LINES
Entity Type:Organization
Organization Name:LEROY CITY LINES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-273-8024
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:MN
Mailing Address - Zip Code:55951-0431
Mailing Address - Country:US
Mailing Address - Phone:507-273-8024
Mailing Address - Fax:
Practice Address - Street 1:122 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:MN
Practice Address - Zip Code:55951-6500
Practice Address - Country:US
Practice Address - Phone:507-273-8024
Practice Address - Fax:507-598-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-21
Last Update Date:2017-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)