Organization
LUCKY MEDICAL SUPPLIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ABDISALAM AHMED (CEO/PRESIDENT)
(612) 229-4715
Entity
Organization
Contact information
Practice address
2910 PILLSBURY AVE S STE 131, MINNEAPOLIS, MN 55408-2335
(612) 229-4715
Mailing address
8133 E BLOOMINGTON FWY APT 312, BLOOMINGTON, MN 55420-1013
(612) 235-7309
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
323P00000X
Psychiatric Residential Treatment Facility
—
—
332100000X
Department of Veterans Affairs (VA) Pharmacy
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
343800000X
Secured Medical Transport (VAN)
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
08/06/2010
Last updated
08/06/2010
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