Provider Demographics
NPI:1770829939
Name:HANDI MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:HANDI MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-287-3532
Mailing Address - Street 1:2505 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1536
Mailing Address - Country:US
Mailing Address - Phone:651-644-9770
Mailing Address - Fax:651-644-0602
Practice Address - Street 1:3960 COON RAPIDS BLVD NW
Practice Address - Street 2:STE #102
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2521
Practice Address - Country:US
Practice Address - Phone:651-789-5858
Practice Address - Fax:651-644-0602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANDI MEDICAL SUPPLY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-17
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN361346332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies