Healthcare Provider Details

I. General information

NPI: 1942843412
Provider Name (Legal Business Name): CHILDREN'S MINNESOTA HOME MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 CHICAGO AVE STE 120
MINNEAPOLIS MN
55404-4541
US

IV. Provider business mailing address

5901 LINCOLN DRIVE CBC-2-REV/PE
EDINA MN
55436-1611
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-7220
  • Fax:
Mailing address:
  • Phone: 952-992-5691
  • Fax: 952-992-6917

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: BRENDA LU ALEXANDER MCCORMICK
Title or Position: SVP AND CFO
Credential:
Phone: 612-813-6129