Provider Demographics
NPI:1629481536
Name:RELIANT TRANSPORTATION MINNESOTA CORPORATION
Entity Type:Organization
Organization Name:RELIANT TRANSPORTATION MINNESOTA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WARNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-281-5780
Mailing Address - Street 1:600 25TH AVE S STE 106
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4820
Mailing Address - Country:US
Mailing Address - Phone:320-281-5780
Mailing Address - Fax:320-281-5781
Practice Address - Street 1:600 25TH AVE S STE 106
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-4820
Practice Address - Country:US
Practice Address - Phone:320-320-5780
Practice Address - Fax:320-281-5781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376264343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)