MEDICARE: MINIMED DISTRIBUTION CORP.

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

General Provider Information

NPI Number	:	1598921975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINIMED DISTRIBUTION CORP.

Provider Business Mailing Address
First Line	:	18000 DEVONSHIRE ST
Second Line	:	ATTN: ANGELA WARD JONES
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-1219
Country	:	US
Telephone Number	:	800-933-3322
Fax Number	:	804-550-2796

Provider Business Practice Location Address
First Line	:	1501 42ND ST
Second Line	:	STE 350
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1005
Country	:	US
Telephone Number	:	800-933-3322
Fax Number	:	804-550-2796

Authorized Official
Title or Position	:	SENIOR COMPLIANCE SPECIALIST
Name	:	ANGELA WARD JONES
Credential	:
Telephone Number	:	804-550-2017

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	04/27/2011

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