Provider Demographics
NPI:1609201433
Name:EAST METRO MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:EAST METRO MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHALEUNSOUK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-280-0356
Mailing Address - Street 1:217 COMO AVE STE 169
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1838
Mailing Address - Country:US
Mailing Address - Phone:651-202-3654
Mailing Address - Fax:651-756-1322
Practice Address - Street 1:217 COMO AVE STE 169
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1838
Practice Address - Country:US
Practice Address - Phone:651-202-3654
Practice Address - Fax:651-756-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies