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
04/17/2024
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