Provider Demographics
NPI:1538105929
Name:ALTRU SPECIALTY SERVICES, INC.
Entity Type:Organization
Organization Name:ALTRU SPECIALTY SERVICES, INC.
Other - Org Name:YORHOM MEDICAL ESSENTIALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-780-1542
Mailing Address - Street 1:1200 SOUTH COLUMBIA ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1808
Practice Address - Country:US
Practice Address - Phone:701-780-5888
Practice Address - Fax:701-780-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN854063200Medicaid
2426939OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MN0253720004Medicare NSC