MEDICARE: NORTH CENTRAL 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	332BX2000X	Oxygen Equipment & Supplies (DME)	4406370	MN

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

General Provider Information

NPI Number	:	1851397376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CENTRAL MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	13287 ISLE DR
Second Line	:
City	:	BAXTER
State	:	MN
Zip	:	56425-8554
Country	:	US
Telephone Number	:	218-825-7331
Fax Number	:	218-822-3888

Provider Business Practice Location Address
First Line	:	13287 ISLE DR
Second Line	:
City	:	BAXTER
State	:	MN
Zip	:	56425-8554
Country	:	US
Telephone Number	:	218-825-7331
Fax Number	:	218-822-3888

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	GRETCHEN RENEE ROGERS
Credential	:
Telephone Number	:	218-454-1539

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	12/19/2022

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