Provider Demographics
NPI:1881872570
Name:SUTRAN
Entity type:Organization
Organization Name:SUTRAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NARDINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-367-7885
Mailing Address - Street 1:500 EAST 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57102-0404
Mailing Address - Country:US
Mailing Address - Phone:605-367-7885
Mailing Address - Fax:605-367-4237
Practice Address - Street 1:500 EAST 6TH STREET
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57102-0404
Practice Address - Country:US
Practice Address - Phone:605-367-7885
Practice Address - Fax:605-367-4237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTRAN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9030330Medicaid