Provider Demographics
NPI:1871890608
Name:RED RIVER SPECIAL TRANSPORT SERVICE LLC.
Entity type:Organization
Organization Name:RED RIVER SPECIAL TRANSPORT SERVICE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER/DRIVER
Authorized Official - Prefix:
Authorized Official - First Name:KIRIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KUTSEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-687-2516
Mailing Address - Street 1:21797 380TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ERSKINE
Mailing Address - State:MN
Mailing Address - Zip Code:56535-9452
Mailing Address - Country:US
Mailing Address - Phone:218-687-2516
Mailing Address - Fax:218-687-2518
Practice Address - Street 1:21797 380TH ST SE
Practice Address - Street 2:
Practice Address - City:ERSKINE
Practice Address - State:MN
Practice Address - Zip Code:56535-9452
Practice Address - Country:US
Practice Address - Phone:218-687-2516
Practice Address - Fax:218-687-2518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA011008345002343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)