Provider Demographics
NPI:1356748727
Name:1ST CHOICE TRANSPORTATION MN
Entity type:Organization
Organization Name:1ST CHOICE TRANSPORTATION MN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WYCLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-220-0772
Mailing Address - Street 1:8500 50TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4117
Mailing Address - Country:US
Mailing Address - Phone:763-220-0772
Mailing Address - Fax:
Practice Address - Street 1:8500 50TH AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-4117
Practice Address - Country:US
Practice Address - Phone:763-220-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker