Organization
HEIDE'S MASTECTOMY SERVICES, INC.
Active
Organization
HEIDE'S MASTECTOMY SERVICES, INC.
Active
Other names
Heide's
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHLEEN RUTH HEIDE-WRAZIDLO CFM CFC (OWNER)
(952) 925-7837
Entity
Organization
Contact information
Practice address
3400 W 66TH ST, SUITE 440, EDINA, MN 55435-2111
(952) 925-7837
(952) 925-1081
Mailing address
3400 W 66TH ST STE 245, EDINA, MN 55435-2170
(952) 925-7837
(952) 925-1081
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
N/A
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01006410
PREFERRED ONE
MN
01
—
106055
UCARE
FM
01
—
15908
HEALTH PARTNERS
MN
01
—
3299743
BCBS
MN
01
—
8211002
MEDICA
MN
05
—
968563400
—
MN
Enumeration date
10/18/2006
Last updated
05/07/2018
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