Provider Demographics
NPI:1851397376
Name:NORTH CENTRAL MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:NORTH CENTRAL MEDICAL SUPPLY, INC.
Other - Org Name:NORTH CENTRAL MEDICAL SUPPLY AND EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-454-1539
Mailing Address - Street 1:13287 ISLE DR
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-8554
Mailing Address - Country:US
Mailing Address - Phone:218-825-7331
Mailing Address - Fax:218-822-3888
Practice Address - Street 1:13287 ISLE DR
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8554
Practice Address - Country:US
Practice Address - Phone:218-825-7331
Practice Address - Fax:218-822-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4406370332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN693818300Medicaid
MN1279540001Medicare ID - Type Unspecified