Provider Demographics
NPI:1013946219
Name:KEY MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:KEY MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-792-3860
Mailing Address - Street 1:5910 RICE CREEK PKWY
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5025
Mailing Address - Country:US
Mailing Address - Phone:651-792-3860
Mailing Address - Fax:651-789-8240
Practice Address - Street 1:5910 RICE CREEK PKWY
Practice Address - Street 2:SUITE 1000
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5025
Practice Address - Country:US
Practice Address - Phone:651-792-3860
Practice Address - Fax:651-789-8240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN129734OtherUCARE
MN72869OtherHEALTH PARTNERS
WI41571600Medicaid
MN030726015OtherPRIMEWEST
MN8214599OtherMEDICA
MN87726OtherUNITED HEALTH CARE
IA0522151Medicaid
030726015OtherMETROPOLITIAN HEALTH PLAN
MN339313500Medicaid
MN12D54KEOtherBLUE CROSS BLUE SHIELD
MN8214599OtherMEDICA
MN87726OtherUNITED HEALTH CARE
MN1287430001Medicare NSC