MEDICARE: EDINA MEDICAL SUPPLIES

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	:	1730605528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDINA MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	7455 FRANCE AVE S # 614
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7455 FRANCE AVE.
Second Line	:	#614 S
City	:	EDINA
State	:	MN
Zip	:	55435
Country	:	US
Telephone Number	:	844-229-4507
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	HUSSNAIN FAROOQ
Credential	:
Telephone Number	:	844-229-4507

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	08/14/2017

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Directions to “EDINA MEDICAL SUPPLIES ” Practice Location

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