Healthcare Provider Details

I. General information

NPI: 1083797252
Provider Name (Legal Business Name): MIDWEST MEDICAL EQUIPMENT & SUPPLIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E 2ND ST
DULUTH MN
55805-1913
US

IV. Provider business mailing address

530 E 2ND ST
DULUTH MN
55805-1913
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-4368
  • Fax: 218-722-9988
Mailing address:
  • Phone: 218-786-4368
  • Fax: 218-722-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BOREN
Title or Position: CFO
Credential:
Phone: 218-786-1009