1932108453 NPI number — CARE MEDICAL SUPPLY INC

Table of content: (NPI 1932108453)

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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