Healthcare Provider Details

I. General information

NPI: 1679861629
Provider Name (Legal Business Name): MINIMED DISTRIBUTION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39555 ORCHARD HILL PL STE 500 ATTN: ANGELA WARD JONES
NOVI MI
48375-5526
US

IV. Provider business mailing address

18000 DEVONSHIRE ST ATTN: ANGELA WARD JONES
NORTHRIDGE CA
91325-1219
US

V. Phone/Fax

Practice location:
  • Phone: 818-576-4978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ANGELA WARD JONES
Title or Position: SENIOR COMPLIANCE SPECIALIST
Credential:
Phone: 804-550-2017