Healthcare Provider Details

I. General information

NPI: 1134542673
Provider Name (Legal Business Name): RELIABLE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 9TH ST NW SUITE 300
ROCHESTER MN
55901
US

IV. Provider business mailing address

9401 WINNETKA AVE N
BROOKLYN PARK MN
55445
US

V. Phone/Fax

Practice location:
  • Phone: 507-218-3880
  • Fax: 507-218-3881
Mailing address:
  • Phone: 763-255-3800
  • Fax: 763-255-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KILEY ANN RUSSELL
Title or Position: DIRECTOR OF PAYOR RELATIONS
Credential:
Phone: 629-252-8211