Organization
IMED MOBILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAYTEY L GILGENBACH (ACCOUNTING)
(651) 635-0655
Entity
Organization
Contact information
Practice address
1915 COUNTY ROAD C W, ROSEVILLE, MN 55113-1320
(651) 635-0655
Mailing address
1915 COUNTY ROAD C W, ROSEVILLE, MN 55113-1320
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
A637163000
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A637163000
PROVIDER NUMBER
MN
Enumeration date
01/11/2012
Last updated
01/11/2012
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