MEDICARE: KATHLEEN BUXTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	CFM00458	MN

General Provider Information

NPI Number	:	1194822791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHLEEN BUXTON

Provider Business Mailing Address
First Line	:	1054 GREEN GABLES RD
Second Line	:
City	:	EAST GULL LAKE
State	:	MN
Zip	:	56401-3167
Country	:	US
Telephone Number	:	218-829-8109
Fax Number	:	218-829-8109

Provider Business Practice Location Address
First Line	:	1054 GREEN GABLES RD
Second Line	:
City	:	EAST GULL LAKE
State	:	MN
Zip	:	56401-3167
Country	:	US
Telephone Number	:	218-829-8109
Fax Number	:	218-829-8109

Authorized Official
Title or Position	:	OWNER
Name	:	KATHLEEN M BUXTON
Credential	:
Telephone Number	:	218-829-8109

Provider Enumeration Date	:	09/18/2006
Last Update Date	:	11/25/2015

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