Organization
OMEGA MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ADERONKE OLANREWAJU MORDI (PRESIDENT AND CEO)
(507) 252-8413
Entity
Organization
Contact information
Practice address
125 WEST MAIN ST, NEW PRAGUE, MN 56071
(507) 252-8413
Mailing address
125 WEST MAIN STREET, NEW PRAGUE, MN 56071-1535
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
7134684
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
331L1OM
BCBS INSURANCE
MN
05
—
397118000
—
MN
Enumeration date
08/14/2012
Last updated
08/28/2012
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