Provider Demographics
NPI:1134542673
Name:RELIABLE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:RELIABLE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYOR RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-252-8211
Mailing Address - Street 1:9401 WINNETKA AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445
Mailing Address - Country:US
Mailing Address - Phone:763-255-3800
Mailing Address - Fax:763-255-3900
Practice Address - Street 1:3555 9TH ST NW
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901
Practice Address - Country:US
Practice Address - Phone:507-218-3880
Practice Address - Fax:507-218-3881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIABLE MEDICAL SUPPLY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-03
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8214389OtherMEDICA CHOICE
MN1030555OtherPREFERRED ONE
MN60677REOtherBLUE CROSS BLUE SHIELD
MN3184OtherHEALTHPARTNERS
MN105239OtherUCARE
MN8200081OtherMEDICA PRIMARY
MN915363200Medicaid