Provider Demographics
NPI:1093782609
Name:RELIABLE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:RELIABLE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR OF PAYOR RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-252-8211
Mailing Address - Street 1:9495 WINNETKA AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-1618
Mailing Address - Country:US
Mailing Address - Phone:629-282-8211
Mailing Address - Fax:763-255-3972
Practice Address - Street 1:440 GREAT OAK DR
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-2505
Practice Address - Country:US
Practice Address - Phone:320-259-5900
Practice Address - Fax:320-259-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8200081OtherMEDICA PRIMARY
MN8214389OtherSELECT CARE
MN1030555OtherPREFERRED ONE
MN3184OtherHEALTHPARTNERS
MN60677REOtherBLUE CROSS BLUE SHIELD
MN765357OtherARAZ
MN8214389OtherMEDICA CHOICE
MN915363200Medicaid
WI41656500Medicaid
MN0990390Medicaid
MN105239OtherUCARE
MN0311990003Medicare NSC