Organization
RANGE REGIONAL HEALTH SERVICES
Active
Parent organization
RANGE REGIONAL HEALTH SERVICES
Other names
HealthLine Medical Supply
Organization subpart
Yes
Provider details
NPI number
Legal business name
RANGE REGIONAL HEALTH SERVICES
Authorized official
DEBRA KATHLEEN BOARDMAN (PRESIDENT & CEO)
(218) 362-6730
Entity
Organization
Contact information
Practice address
2716 CRESCENT DRIVE, SUITE 1, INTERNATIONAL FALLS, MN 56649-2198
(218) 283-4174
(218) 283-5561
Mailing address
1101 EAST 37TH STREET, SUITE 18, GIBBING, MN 55746-2973
(218) 262-6981
(218) 262-5756
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110274
UCARE
MN
01
—
461R0HE
BLUECROSS BLUESHIELD
MN
01
—
82-14495
MEDICA
MN
05
—
868182000
—
MN
Enumeration date
03/07/2006
Last updated
07/09/2013
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