Boomer Ride

Primary specialty

Private VehicleTaxonomy code 347C00000X

License

C893012006120 Issued in MN

Legal business name

BOOMER RIDE

Practice address

724 5TH St W Apt B
Hastings, MN 55033-1745

Phone

(651) 263-0189

NPI assigned

Nov 17, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Leslie Dean Howard

Title

Owner

Phone

(651) 263-0189

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416182400000",
    "number": "1194121210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 5TH ST W APT B",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550331745",
            "telephone_number": "651-263-0189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 5TH ST W APT B",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550331745",
            "telephone_number": "651-263-0189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOOMER RIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-17",
        "last_updated": "2014-11-17",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-263-0189",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "MN",
            "license": "C893012006120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bio-Medical Applications of Minnesota, Inc.
• Jennifer Marie Bloemendal, DPT
• Cynthia Bocwinski, PHARM.D
• Bolat Incorporated
• Tamirah Florence Bonaby
• Jane Borner, MSPT
• Daniel Thomas Boston, LICSW
• Robert Bradley, D.C
• Meghan Elizabeth Brant, PAC
• Kelly Marie Brasher, MA

• Private Vehicle in Hastings, MN
• Providers in Hastings, MN by specialty
• Private Vehicle in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.