Provider Demographics
NPI:1649493248
Name:ANY TIME TRANSPORTATION
Entity type:Organization
Organization Name:ANY TIME TRANSPORTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-232-3322
Mailing Address - Street 1:1107 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1744
Mailing Address - Country:US
Mailing Address - Phone:701-232-3322
Mailing Address - Fax:701-232-3399
Practice Address - Street 1:1107 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1744
Practice Address - Country:US
Practice Address - Phone:701-232-3322
Practice Address - Fax:701-232-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN434M3ANMedicaid
MN81-00038Medicaid