Provider Demographics
NPI:1447417969
Name:MINIMED DISTRIBUTION CORP
Entity Type:Organization
Organization Name:MINIMED DISTRIBUTION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR COMPLIANCE SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-262-6492
Mailing Address - Street 1:18000 DEVONSHIRE ST
Mailing Address - Street 2:ATTN: ANGELA WARD, LEGAL DEPT.
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1219
Mailing Address - Country:US
Mailing Address - Phone:804-262-6492
Mailing Address - Fax:818-576-6228
Practice Address - Street 1:40 CALHOUN ST
Practice Address - Street 2:STE 475
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-3500
Practice Address - Country:US
Practice Address - Phone:804-262-6492
Practice Address - Fax:804-262-6493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINIMED DISTRIBUTION CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies