Provider Demographics
NPI:1003966425
Name:PMM, LLC DBA MEDITRAN SYSTEMS
Entity Type:Organization
Organization Name:PMM, LLC DBA MEDITRAN SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOSEFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-201-1463
Mailing Address - Street 1:15105 MINNETONKA INDUSTRIAL RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-2103
Mailing Address - Country:US
Mailing Address - Phone:952-314-4548
Mailing Address - Fax:952-516-5560
Practice Address - Street 1:15105 MINNETONKA INDUSTRIAL ROAD
Practice Address - Street 2:SUITE 125
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-2106
Practice Address - Country:US
Practice Address - Phone:952-314-4548
Practice Address - Fax:952-516-5560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5538780001Medicare NSC