MEDICARE: RELIABLE MEDICAL SUPPLY 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
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1710538152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	9401 WINNETKA AVENUE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445
Country	:	US
Telephone Number	:	763-255-3800
Fax Number	:	763-255-3900

Provider Business Practice Location Address
First Line	:	313 2ND AVE NE
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-3430
Country	:	US
Telephone Number	:	507-433-9000
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PAYOR RELATIONS
Name	:	KILEY ANN RUSSELL
Credential	:
Telephone Number	:	629-252-8211

Provider Enumeration Date	:	09/26/2019
Last Update Date	:	01/27/2022

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