MEDICARE: HANDI 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

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	:	1922006741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANDI MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	2505 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1536
Country	:	US
Telephone Number	:	651-644-9770
Fax Number	:	651-644-0602

Provider Business Practice Location Address
First Line	:	2505 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1536
Country	:	US
Telephone Number	:	651-644-9770
Fax Number	:	651-644-0602

Authorized Official
Title or Position	:	CEO
Name	:	SHAUN ROBISON
Credential	:
Telephone Number	:	651-287-3532

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	10/18/2024

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