MEDICARE: MINIMED DISTRIBUTION CORP.

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

General Provider Information

NPI Number	:	1396984977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINIMED DISTRIBUTION CORP.

Provider Business Mailing Address
First Line	:	18000 DEVONSHIRE ST
Second Line	:	ATTN: ANGELA WARD
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-1219
Country	:	US
Telephone Number	:	800-646-4633
Fax Number	:	818-576-6228

Provider Business Practice Location Address
First Line	:	5665 SW MEADOWS RD
Second Line	:	SUITE 100
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3159
Country	:	US
Telephone Number	:	800-646-4633
Fax Number	:	818-576-6228

Authorized Official
Title or Position	:	SENIOR COMPLIANCE SPECIALIST
Name	:	ANGELA E WARD
Credential	:
Telephone Number	:	804-262-6492

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	02/05/2009

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