Provider Demographics
NPI:1093804031
Name:MINNESOTA MEDICAL BUYERS SOURCE
Entity Type:Organization
Organization Name:MINNESOTA MEDICAL BUYERS SOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DENHARTOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-447-4753
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-0181
Mailing Address - Country:US
Mailing Address - Phone:612-240-1909
Mailing Address - Fax:
Practice Address - Street 1:7801 W 128TH ST
Practice Address - Street 2:SUITE 1502
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-1138
Practice Address - Country:US
Practice Address - Phone:612-240-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies