1902063381 NPI number — MINIMED DISTRIBUTION CORP

Table of content: (NPI 1902063381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902063381 NPI number — MINIMED DISTRIBUTION CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MINIMED DISTRIBUTION CORP
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:
1902063381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18000 DEVONSHIRE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91325-1219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-262-6492
Provider Business Mailing Address Fax Number:
818-576-6228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3555 KOGER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30096-7624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-646-4633
Provider Business Practice Location Address Fax Number:
818-739-4843
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNEIDER
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
SR PAYER RELATIONS ANALYST
Authorized Official Telephone Number:
818-576-5728

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: 003279549A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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