MEDICARE: MEDICAL SUPPLIES & UNIFORMS - HCD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	L0673875456	MN

General Provider Information

NPI Number	:	1376885319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL SUPPLIES & UNIFORMS - HCD

Provider Business Mailing Address
First Line	:	8062 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2407
Country	:	US
Telephone Number	:	763-657-0457
Fax Number	:

Provider Business Practice Location Address
First Line	:	8062 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2407
Country	:	US
Telephone Number	:	763-657-0457
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA KUSI MENSAH
Credential	:
Telephone Number	:	612-545-8027

Provider Enumeration Date	:	03/16/2013
Last Update Date	:	03/16/2013

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