Organization
COUNTRY VAN SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL ERICKSON (OWNER)
(507) 872-5300
Entity
Organization
Contact information
Practice address
700 NORTH MONROE, MINNEOTA, MN 56264
(507) 872-5300
Mailing address
700 NORTH MONROE, PO BOX 117, MINNEOTA, MN 56264
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
VYW819
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153546
MN DOT CERTIFICATE
MN
Enumeration date
02/04/2008
Last updated
02/04/2008
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