Provider Demographics
NPI:1679861629
Name:MINIMED DISTRIBUTION CORP
Entity Type:Organization
Organization Name:MINIMED DISTRIBUTION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR COMPLIANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-550-2017
Mailing Address - Street 1:18000 DEVONSHIRE ST
Mailing Address - Street 2:ATTN: ANGELA WARD JONES
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39555 ORCHARD HILL PL STE 500
Practice Address - Street 2:ATTN: ANGELA WARD JONES
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-5526
Practice Address - Country:US
Practice Address - Phone:818-576-4978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINIMED DISTRIBUTION CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-12
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies