1851397376 NPI number — NORTH CENTRAL MEDICAL SUPPLY, INC.

Table of content: CHANDRA A NORDER-BRANDLI N.P. (NPI 1932532009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851397376 NPI number — NORTH CENTRAL MEDICAL SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH CENTRAL 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:
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:
1851397376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13287 ISLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAXTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56425-8554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-825-7331
Provider Business Mailing Address Fax Number:
218-822-3888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13287 ISLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAXTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56425-8554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-825-7331
Provider Business Practice Location Address Fax Number:
218-822-3888
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
GRETCHEN
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
218-454-1539

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  4406370 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 693818300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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