Provider Demographics
NPI:1215583802
Name:KERRI ANNE BUSS TRANSPORTATION
Entity Type:Organization
Organization Name:KERRI ANNE BUSS TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-337-3563
Mailing Address - Street 1:2247 169TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-5002
Mailing Address - Country:US
Mailing Address - Phone:763-337-3563
Mailing Address - Fax:
Practice Address - Street 1:2247 169TH AVE NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-5002
Practice Address - Country:US
Practice Address - Phone:763-337-3563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)