Provider Demographics
NPI:1407545601
Name:MILK MARKET LLC
Entity Type:Organization
Organization Name:MILK MARKET LLC
Other - Org Name:MILK MARKET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:612-799-9195
Mailing Address - Street 1:4302 13TH AVE S STE 4-328
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3395
Mailing Address - Country:US
Mailing Address - Phone:612-799-9195
Mailing Address - Fax:
Practice Address - Street 1:1801 45TH ST S STE E
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-0801
Practice Address - Country:US
Practice Address - Phone:701-532-0284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty