Provider Demographics
NPI:1619337979
Name:QUAD CITY CAB LLC
Entity Type:Organization
Organization Name:QUAD CITY CAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:GULBRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-750-6672
Mailing Address - Street 1:4778 DIFFERDING POINT RD
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-8708
Mailing Address - Country:US
Mailing Address - Phone:218-749-5000
Mailing Address - Fax:218-744-9645
Practice Address - Street 1:4778 DIFFERDING POINT RD
Practice Address - Street 2:
Practice Address - City:EVELETH
Practice Address - State:MN
Practice Address - Zip Code:55734-8708
Practice Address - Country:US
Practice Address - Phone:218-749-5000
Practice Address - Fax:218-744-9645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2KT71QUOtherBCBSMN INTERNAL REFERENCE NUMBER