Organization
SUBURBAN MEDICAL EQUIPMENT & SUPPLY LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MITCHELL C MADSEN PEDORTHIST (OWNER)
(763) 274-2299
Entity
Organization
Contact information
Practice address
6003 167TH AVE NW, RAMSEY, MN 55303-3783
(763) 274-2299
(866) 460-2892
Mailing address
6003 167TH AVE NW, RAMSEY, MN 55303-3783
(763) 274-2299
(866) 460-2892
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
183495
UCARE
MN
01
—
357A4SU
BLUECROSS BLUESHIELD
MN
01
—
82-00705
MEDICA
MN
05
—
877376900
—
MN
Enumeration date
12/20/2006
Last updated
07/08/2009
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