Provider Demographics
NPI:1366506883
Name:SUBURBAN MEDICAL EQUIPMENT & SUPPLY LLC.
Entity Type:Organization
Organization Name:SUBURBAN MEDICAL EQUIPMENT & SUPPLY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PEDORTHIST
Authorized Official - Phone:763-274-2299
Mailing Address - Street 1:6003 167TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-3783
Mailing Address - Country:US
Mailing Address - Phone:763-274-2299
Mailing Address - Fax:866-460-2892
Practice Address - Street 1:6003 167TH AVE NW
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-3783
Practice Address - Country:US
Practice Address - Phone:763-274-2299
Practice Address - Fax:866-460-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN183495OtherUCARE
MN357A4SUOtherBLUECROSS BLUESHIELD
MN877376900Medicaid
MN82-00705OtherMEDICA
MN877376900Medicaid
MN877376900Medicaid