Provider Demographics
NPI:1497702583
Name:FLAD ENTERPRISES, INC
Entity Type:Organization
Organization Name:FLAD ENTERPRISES, INC
Other - Org Name:BOURNE MEDICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-454-1315
Mailing Address - Street 1:163 WALNUT ST
Mailing Address - Street 2:P O BOX 111
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3404
Mailing Address - Country:US
Mailing Address - Phone:507-452-1313
Mailing Address - Fax:507-454-5717
Practice Address - Street 1:163 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3404
Practice Address - Country:US
Practice Address - Phone:507-452-1313
Practice Address - Fax:507-454-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4598806332B00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01021520OtherPREFERRED ONE
WI41692900Medicaid
MN6G059FLOtherBLUE CROSS BLUE SHEILD MN
MN167458OtherUCARE
MNMEDICAOther8200512
MN612220500Medicaid
MN47764OtherHEALTH PARTNERS
MN612220500Medicaid