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
1	332BC3200X	Customized Equipment (DME)
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)
4	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	105239	OTHER	MN	UCARE
4	1030555	OTHER	MN	PREFERRED ONE
5	8214389	OTHER	MN	MEDICA CHOICE
6	8200081	OTHER	MN	MEDICA PRIMARY
7	765357	OTHER	FM	ARAZ
8	8214389	OTHER	MN	SELECT CARE
9	3184	OTHER	MN	HEALTHPARTNERS
10	60677RE	OTHER	MN	BLUE CROSS BLUE SHIELD
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710984869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	9495 WINNETKA AVE N STE 200
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-1618
Country	:	US
Telephone Number	:	629-282-8211
Fax Number	:	763-255-3972

Provider Business Practice Location Address
First Line	:	9495 WINNETKA AVE N STE 200
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-1618
Country	:	US
Telephone Number	:	763-255-3800
Fax Number	:	763-255-3900

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	04/17/2024

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