Provider Demographics
NPI:1710954821
Name:RANGE REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:RANGE REGIONAL HEALTH SERVICES
Other - Org Name:HEALTHLINE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:BOARDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-362-6730
Mailing Address - Street 1:1101 EAST 37TH STREET
Mailing Address - Street 2:SUITE 18
Mailing Address - City:GIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2973
Mailing Address - Country:US
Mailing Address - Phone:218-262-6981
Mailing Address - Fax:218-262-5756
Practice Address - Street 1:2716 CRESCENT DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2198
Practice Address - Country:US
Practice Address - Phone:218-283-4174
Practice Address - Fax:218-283-5561
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RANGE REGIONAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-07
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN868182000Medicaid
MN82-14495OtherMEDICA
MN110274OtherUCARE
MN461R0HEOtherBLUECROSS BLUESHIELD
MN868182000Medicaid