Provider Demographics
NPI:1679704332
Name:SIRIUS INC
Entity Type:Organization
Organization Name:SIRIUS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ZHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBROVETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-577-0012
Mailing Address - Street 1:14210 46TH PL N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3493
Mailing Address - Country:US
Mailing Address - Phone:763-577-0012
Mailing Address - Fax:763-577-0013
Practice Address - Street 1:8700 W 36TH ST # F217
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3906
Practice Address - Country:US
Practice Address - Phone:612-850-4343
Practice Address - Fax:952-933-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNSTS 310211343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN08Z65S1OtherBCBS OF MINNESOTA