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NPI Code Detail

MEDICARE: GESIVA MEDICAL, LLC

MEDICARE: GESIVA MEDICAL, 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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1467928259
Entity Type Code : Organization
Provider Name (Legal Business Name) : GESIVA MEDICAL, LLC
Provider Business Mailing Address
First Line : 6385 OLD SHADY OAK RD STE 250
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7705
Country : US
Telephone Number : 866-344-3748
Fax Number :
Provider Business Practice Location Address
First Line : 6385 OLD SHADY OAK RD STE 250
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7705
Country : US
Telephone Number : 866-344-3748
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : THOMAS HOPPER
Credential :
Telephone Number : 952-843-8439
Provider Enumeration Date : 10/18/2018
Last Update Date : 10/18/2018

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