Organization
POWER CHAIRS AND SCOOTER STORE MEDICAL SUPPLY LLC
Active
Other names
Pine City Medical Supply, Forest Lake Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
JOEL R ERICKSON (OWNER / PRESIDENT)
(651) 982-0002
Entity
Organization
Contact information
Practice address
540 MAIN ST S, PINE CITY, MN 55063
(320) 629-1149
(320) 629-1287
Mailing address
540 MAIN ST S, PINE CITY, MN 55063-1659
(320) 629-1149
(320) 629-1287
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346684289
—
MN
05
—
1447560057
—
MN
Enumeration date
04/22/2013
Last updated
10/10/2018
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