Provider Demographics
NPI:1790120210
Name:BIOSCRIP MEDICAL SUPPLY SERVICES, LLC
Entity Type:Organization
Organization Name:BIOSCRIP MEDICAL SUPPLY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP, GENERAL COUNSEL, SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-697-5153
Mailing Address - Street 1:10050 CROSSTOWN CIR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3348
Mailing Address - Country:US
Mailing Address - Phone:952-979-3680
Mailing Address - Fax:952-352-6698
Practice Address - Street 1:108 LUNDY LN
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6601
Practice Address - Country:US
Practice Address - Phone:855-267-4391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12286/11.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies