Provider Demographics
NPI:1891034930
Name:ACCOUNTABLE MEDICAL EQUIPMENT & SUPPLY
Entity Type:Organization
Organization Name:ACCOUNTABLE MEDICAL EQUIPMENT & SUPPLY
Other - Org Name:1ST CHOICE PEDIATRIC HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LYNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-770-4177
Mailing Address - Street 1:226 COLFAX AVE N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-1425
Mailing Address - Country:US
Mailing Address - Phone:612-770-4177
Mailing Address - Fax:612-454-2664
Practice Address - Street 1:226 COLFAX AVE N
Practice Address - Street 2:SUITE 102
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-1425
Practice Address - Country:US
Practice Address - Phone:612-770-4177
Practice Address - Fax:612-454-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-09
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29156251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA594517800Medicaid