Organization
RELIABLE MEDICAL SUPPLY LLC
Active
Organization
RELIABLE MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KILEY ANN RUSSELL (SENIOR DIRECTOR OF PAYOR RELATIONS)
(629) 252-8211
Entity
Organization
Contact information
Practice address
9495 WINNETKA AVE N STE 200, BROOKLYN PARK, MN 55445-1618
(763) 255-3800
(763) 255-3900
Mailing address
9495 WINNETKA AVE N STE 200, BROOKLYN PARK, MN 55445-1618
(629) 282-8211
(763) 255-3972
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0990390
—
IA
01
—
1030555
PREFERRED ONE
MN
01
—
105239
UCARE
MN
01
—
3184
HEALTHPARTNERS
MN
05
—
41656500
—
WI
01
—
60677RE
BLUE CROSS BLUE SHIELD
MN
01
—
765357
ARAZ
FM
01
—
8200081
MEDICA PRIMARY
MN
01
—
8214389
MEDICA CHOICE
MN
05
—
915363200
—
MN
Enumeration date
07/05/2005
Last updated
06/04/2026
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