Provider Demographics
NPI:1508179649
Name:ELECTROMED, INC.
Entity Type:Organization
Organization Name:ELECTROMED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYER RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-758-9299
Mailing Address - Street 1:500 6TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-1134
Mailing Address - Country:US
Mailing Address - Phone:952-758-9299
Mailing Address - Fax:
Practice Address - Street 1:4590 ISH DR UNIT 150
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-7678
Practice Address - Country:US
Practice Address - Phone:952-758-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELECTROMED, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN040M2ELOtherBLUE CROSS BLUE SHIELD
CA1508179649Medicaid