MEDICARE: T.D. MEDICAL 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	332BC3200X	Customized Equipment (DME)	596	FL
2	332BX2000X	Oxygen Equipment & Supplies (DME)	596	FL
3	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861462244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T.D. MEDICAL 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	:	629-252-8211
Fax Number	:	763-255-3972

Provider Business Practice Location Address
First Line	:	12323 SW 55TH ST STE 1004
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33330-3312
Country	:	US
Telephone Number	:	954-921-9099
Fax Number	:	954-921-1937

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	04/17/2024

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Directions to “T.D. MEDICAL LLC ” Practice Location

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