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NPI Code Detail

MEDICARE: CUSTOM MEDICAL EQUIPMENT LLC

MEDICARE: CUSTOM MEDICAL EQUIPMENT LLC
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
1332BC3200XCustomized Equipment (DME)9615269MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306093463
Entity Type Code : Organization
Provider Name (Legal Business Name) : CUSTOM MEDICAL EQUIPMENT LLC
Provider Business Mailing Address
First Line : 1001 S POKEGAMA AVE STE A
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-3919
Country : US
Telephone Number : 218-326-2212
Fax Number :
Provider Business Practice Location Address
First Line : 1001 S POKEGAMA AVE STE A
Second Line :
City : GRAND RAPIDS
State : MN
Zip : 55744-3919
Country : US
Telephone Number : 218-326-2212
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. JOSEPHINE LYN CZERNY
Credential : CRTS
Telephone Number : 218-326-2212
Provider Enumeration Date : 08/20/2008
Last Update Date : 08/19/2022

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Directions to “CUSTOM MEDICAL EQUIPMENT LLC ” Practice Location

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