1881809622 NPI number — CUSA ES. LLC TAXI 9000 BISMARCK

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881809622 NPI number — CUSA ES. LLC TAXI 9000 BISMARCK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUSA ES. LLC TAXI 9000 BISMARCK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881809622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 E ROSSER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISMARCK
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-223-9035
Provider Business Mailing Address Fax Number:
701-258-7393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 E ROSSER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-223-9035
Provider Business Practice Location Address Fax Number:
701-258-7393
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROEHRICH
Authorized Official First Name:
JANESSA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE ASSITANT
Authorized Official Telephone Number:
701-223-9035

Provider Taxonomy Codes

  • Taxonomy code: 344600000X , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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