Healthcare Provider Details

I. General information

NPI: 1245504489
Provider Name (Legal Business Name): BRIDGE MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E FRANKLIN AVE
MINNEAPOLIS MN
55406-1103
US

IV. Provider business mailing address

2615 E FRANKLIN AVE
MINNEAPOLIS MN
55406-1103
US

V. Phone/Fax

Practice location:
  • Phone: 612-332-2280
  • Fax: 612-333-1445
Mailing address:
  • Phone: 612-332-2280
  • Fax: 612-333-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4012349-2
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number4012349-2
License Number StateMN

VIII. Authorized Official

Name: MR. IDRIS H MOHAMED
Title or Position: OWNER/CEO
Credential:
Phone: 612-332-2280