1710984869 NPI number — RELIABLE MEDICAL SUPPLY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710984869 NPI number — RELIABLE MEDICAL SUPPLY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIABLE MEDICAL SUPPLY LLC
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:
1710984869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9495 WINNETKA AVE N STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55445-1618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
629-282-8211
Provider Business Mailing Address Fax Number:
763-255-3972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9495 WINNETKA AVE N STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55445-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-255-3800
Provider Business Practice Location Address Fax Number:
763-255-3900
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
KILEY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
SENIOR DIRECTOR OF PAYOR RELATIONS
Authorized Official Telephone Number:
629-252-8211

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 41656500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0990390 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105239 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1030555 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8214389 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8200081 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 765357 . This is a "ARAZ" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 8214389 . This is a "SELECT CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3184 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 60677RE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 915363200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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