1013946219 NPI number — KEY MEDICAL SUPPLY, INC

Table of content: (NPI 1013946219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013946219 NPI number — KEY MEDICAL SUPPLY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEY MEDICAL SUPPLY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013946219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5910 RICE CREEK PKWY
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
SHOREVIEW
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55126-5025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-792-3860
Provider Business Mailing Address Fax Number:
651-789-8240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5910 RICE CREEK PKWY
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
SHOREVIEW
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55126-5025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-792-3860
Provider Business Practice Location Address Fax Number:
651-789-8240
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
JACKIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
651-792-3860

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 129734 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 72869 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41571600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030726015 . This is a "PRIMEWEST" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8214599 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0522151 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030726015 . This is a "METROPOLITIAN HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 339313500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12D54KE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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