Organization
CUSTOM MEDICAL EQUIPMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOSEPHINE LYN CZERNY CRTS (OWNER)
(218) 326-2212
Entity
Organization
Contact information
Practice address
1001 S POKEGAMA AVE STE A, GRAND RAPIDS, MN 55744-3919
(218) 326-2212
Mailing address
1001 S POKEGAMA AVE STE A, GRAND RAPIDS, MN 55744-3919
(218) 326-2212
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
9615269
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
697697100
—
MN
Enumeration date
08/20/2008
Last updated
08/19/2022
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