Provider Demographics
NPI:1467738237
Name:STELLAR VIP LIMOUSINE, LLC
Entity Type:Organization
Organization Name:STELLAR VIP LIMOUSINE, LLC
Other - Org Name:STELLAR MOBILITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-335-4041
Mailing Address - Street 1:609 N KIWANIS AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-1819
Mailing Address - Country:US
Mailing Address - Phone:605-335-4041
Mailing Address - Fax:
Practice Address - Street 1:609 N KIWANIS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-1819
Practice Address - Country:US
Practice Address - Phone:605-335-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STELLAR VIP LIMOUSINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10120953ST343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)