1932108453 NPI number — CARE MEDICAL SUPPLY INC

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 1932108453 NPI number — CARE MEDICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE 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:
1932108453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 S BENTON DR
Provider Second Line Business Mailing Address:
SUITE 418
Provider Business Mailing Address City Name:
SAUK RAPIDS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56379-1227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-251-8261
Provider Business Mailing Address Fax Number:
320-251-7023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 S BENTON DR
Provider Second Line Business Practice Location Address:
SUITE 418
Provider Business Practice Location Address City Name:
SAUK RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56379-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-251-8261
Provider Business Practice Location Address Fax Number:
320-251-7023
Provider Enumeration Date:
07/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
TONJA
Authorized Official Middle Name:
LEA
Authorized Official Title or Position:
C.E.O.
Authorized Official Telephone Number:
320-251-8261

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: 110492 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8200123 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 885863200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13747CA . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1010935 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21482 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".




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