Provider Demographics
NPI:1356507966
Name:SOARING EAGLES TRANSPORTATION, INC.
Entity Type:Organization
Organization Name:SOARING EAGLES TRANSPORTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-656-3268
Mailing Address - Street 1:14279 42ND ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-6702
Mailing Address - Country:US
Mailing Address - Phone:888-387-5298
Mailing Address - Fax:877-570-8720
Practice Address - Street 1:14279 42ND ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-6702
Practice Address - Country:US
Practice Address - Phone:888-387-5298
Practice Address - Fax:877-570-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-03
Last Update Date:2008-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNSTS # 374680343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)