Provider Demographics
NPI:1689983900
Name:SUBURBAN MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:SUBURBAN MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MADSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-274-2299
Mailing Address - Street 1:637 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1623
Mailing Address - Country:US
Mailing Address - Phone:763-274-2299
Mailing Address - Fax:866-460-2892
Practice Address - Street 1:637 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1623
Practice Address - Country:US
Practice Address - Phone:763-274-2299
Practice Address - Fax:866-460-2892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6480820001OtherMEDICARE-PTAN
MN877376900Medicaid