Organization
PROVIDACARE MEDICAL SUPPLY LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADAM WAYNE BLUMENSHEIN (PARTNER)
(512) 733-6518
Entity
Organization
Contact information
Practice address
831 E 2ND ST, DULUTH, MN 55805-2103
(218) 727-5555
(218) 727-9999
Mailing address
3721 EXECUTIVE CENTER DR, SUITE 102, AUSTIN, TX 78731-1645
(512) 733-6518
(512) 795-9185
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/03/2008
Last updated
01/30/2009
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