Healthcare Provider Details

I. General information

NPI: 1689983900
Provider Name (Legal Business Name): SUBURBAN MEDICAL EQUIPMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 W MAIN ST
ANOKA MN
55303-1623
US

IV. Provider business mailing address

637 W MAIN ST
ANOKA MN
55303-1623
US

V. Phone/Fax

Practice location:
  • Phone: 763-274-2299
  • Fax: 866-460-2892
Mailing address:
  • Phone: 763-274-2299
  • Fax: 866-460-2892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MITCHELL C MADSEN
Title or Position: PRESIDENT
Credential:
Phone: 763-274-2299