Provider Demographics
NPI:1477807998
Name:CHOICE MEDICAL SUPPLY MN
Entity Type:Organization
Organization Name:CHOICE MEDICAL SUPPLY MN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:CHI
Authorized Official - Last Name:NDIKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-486-6252
Mailing Address - Street 1:2353 RICE ST.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2353 RICE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3739
Practice Address - Country:US
Practice Address - Phone:651-486-6252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies