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General NPI Number Information
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NPI Number | 1609201433
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Entity Type | Organization
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Legal Business Name | EAST METRO MEDICAL SUPPLY, INC
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 217 COMO AVE STE 169
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City | SAINT PAUL
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State | MN
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Zip | 55103-1838
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Country | US
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Telephone | 651-202-3654
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Fax | 651-756-1322
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Provider Business Mailing Address
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Address Line | 217 COMO AVE STE 169
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City | SAINT PAUL
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State | MN
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Zip | 55103-1838
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Country | US
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Telephone | 651-202-3654
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Fax | 651-756-1322
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Authorized Official
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Title or Position | CEO
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Name | MR. CHALEUNSOUK VANG
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Credential |
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Telephone | 651-280-0356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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