1386037695 NPI number — RELIABLE EQUIPMENT AND MEDICAL SUPPLIES, 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 1386037695 NPI number — RELIABLE EQUIPMENT AND MEDICAL SUPPLIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIABLE EQUIPMENT AND MEDICAL SUPPLIES, 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:
6
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:
1386037695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5701 SHINGLE CREEK PKWY
Provider Second Line Business Mailing Address:
SUITE 470
Provider Business Mailing Address City Name:
BROOKLYN CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55430-2467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-442-5136
Provider Business Mailing Address Fax Number:
763-219-8482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5701 SHINGLE CREEK PKWY
Provider Second Line Business Practice Location Address:
SUITE 470
Provider Business Practice Location Address City Name:
BROOKLYN CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55430-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-442-5136
Provider Business Practice Location Address Fax Number:
763-219-8482
Provider Enumeration Date:
03/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KOLLEH
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
KANMUE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
763-440-5136

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)





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