Provider Demographics
NPI:1245350016
Name:BEMIDJI MEDICAL EQUIPMENT INC
Entity type:Organization
Organization Name:BEMIDJI MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-333-5508
Mailing Address - Street 1:3503 PINE RIDGE AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601
Mailing Address - Country:US
Mailing Address - Phone:218-751-8036
Mailing Address - Fax:218-751-9728
Practice Address - Street 1:3503 PINE RIDGE AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601
Practice Address - Country:US
Practice Address - Phone:218-751-8036
Practice Address - Fax:218-751-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1049138OtherPREFERRED ONE
8200694OtherMEDICA
MN83365BEOtherBCBS
0326940001Medicare ID - Type Unspecified