Organization
SIRIUS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS ZHANNA DOBROVETSKY (PRESIDENT)
(763) 577-0012
Entity
Organization
Contact information
Practice address
8700 W 36TH ST # F217, ST LOUIS PARK, MN 55426-3906
(612) 850-4343
(952) 933-9779
Mailing address
14210 46TH PL N, PLYMOUTH, MN 55446-3493
(763) 577-0012
(763) 577-0013
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
STS 310211
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08Z65S1
BCBS OF MINNESOTA
MN
Enumeration date
07/29/2009
Last updated
07/29/2009
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