Provider Demographics
NPI:1417101254
Name:DEAN T WEBER
Entity Type:Organization
Organization Name:DEAN T WEBER
Other - Org Name:FOLEY MEDICAL SUPPLY CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:320-968-7797
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56329-0548
Mailing Address - Country:US
Mailing Address - Phone:320-968-7797
Mailing Address - Fax:320-968-8869
Practice Address - Street 1:20 2ND AVE W
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:MN
Practice Address - Zip Code:56329-8514
Practice Address - Country:US
Practice Address - Phone:320-968-7797
Practice Address - Fax:320-968-8869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4463584332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN058484300Medicaid
MN058484300Medicaid