MEDICARE: ROS MEDICAL SUPPLY INC

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	:	1720712797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROS MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	6409 CITY WEST PKWY STE 100
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7845
Country	:	US
Telephone Number	:	952-209-2820
Fax Number	:

Provider Business Practice Location Address
First Line	:	6409 CITY WEST PKWY STE 100
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7845
Country	:	US
Telephone Number	:	952-209-2820
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RADA SHEVTSOV
Credential	:
Telephone Number	:	612-247-1547

Provider Enumeration Date	:	07/14/2022
Last Update Date	:	03/04/2024

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