Basic Information
| Provider Information | |||||||||
| NPI: | 1942843412 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S MINNESOTA HOME MEDICAL EQUIPMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5901 LINCOLN DRIVE | ||||||||
| Address2: | CBC-2-REV/PE | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554361611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529925691 | ||||||||
| FaxNumber: | 9529926917 | ||||||||
| Practice Location | |||||||||
| Address1: | 2545 CHICAGO AVE STE 120 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554044541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128137220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2019 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCCORMICK | ||||||||
| AuthorizedOfficialFirstName: | BRENDA LU | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 6128136129 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.