Provider Demographics
NPI:1982814042
Name:PATIENT CARE SERVICES
Entity Type:Organization
Organization Name:PATIENT CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-842-7380
Mailing Address - Street 1:7100 NORTHLAND CIR N
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-1548
Mailing Address - Country:US
Mailing Address - Phone:763-535-0118
Mailing Address - Fax:763-536-0932
Practice Address - Street 1:8601 73RD AVE N
Practice Address - Street 2:SUITE 16
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-1507
Practice Address - Country:US
Practice Address - Phone:763-535-0118
Practice Address - Fax:763-536-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5469470006Medicare NSC