Provider Demographics
NPI:1912185067
Name:MEGAMAR, INC.
Entity Type:Organization
Organization Name:MEGAMAR, INC.
Other - Org Name:TRI STATE LIFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:ZVORAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-455-3553
Mailing Address - Street 1:10048 SW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:MN
Mailing Address - Zip Code:56026-2017
Mailing Address - Country:US
Mailing Address - Phone:507-455-3553
Mailing Address - Fax:507-455-3053
Practice Address - Street 1:10048 SW 37TH AVE
Practice Address - Street 2:
Practice Address - City:ELLENDALE
Practice Address - State:MN
Practice Address - Zip Code:56026-2017
Practice Address - Country:US
Practice Address - Phone:507-455-3553
Practice Address - Fax:507-455-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN072669-RC332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN965125000Medicaid