Provider Demographics
NPI:1912359308
Name:OMARIBA, BEUTER
Entity Type:Individual
Prefix:
First Name:BEUTER
Middle Name:
Last Name:OMARIBA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 N OAKS DR APT 307
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1438
Mailing Address - Country:US
Mailing Address - Phone:651-354-8399
Mailing Address - Fax:
Practice Address - Street 1:624 N OAKS DR APT 307
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1438
Practice Address - Country:US
Practice Address - Phone:651-354-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)