=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154936540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAERUS CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2020
-----------------------------------------------------
Last Update Date | 09/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1251 RED FOX RD # 603
-----------------------------------------------------
City | ARDEN HILLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55112-6943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-217-6366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1251 RED FOX RD # 603
-----------------------------------------------------
City | ARDEN HILLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55112-6943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-217-6366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN F DINUSSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 952-217-6366
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------