Provider Demographics
NPI:1376175448
Name:VEREMCHUK, VITALIY (MN DOT STS 383588)
Entity Type:Individual
Prefix:
First Name:VITALIY
Middle Name:
Last Name:VEREMCHUK
Suffix:
Gender:M
Credentials:MN DOT STS 383588
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15200 HELIUM ST NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-6143
Mailing Address - Country:US
Mailing Address - Phone:507-581-1470
Mailing Address - Fax:
Practice Address - Street 1:15200 HELIUM ST NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-6143
Practice Address - Country:US
Practice Address - Phone:507-581-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN383588343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)