Provider Demographics
| NPI: | 1780998377 |
|---|---|
| Name: | LUCKY MEDICAL SUPPLIES |
| Entity type: | Organization |
| Organization Name: | LUCKY MEDICAL SUPPLIES |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO/PRESIDENT |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | ABDISALAM |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | AHMED |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 612-229-4715 |
| Mailing Address - Street 1: | 8133 E BLOOMINGTON FWY APT 312 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BLOOMINGTON |
| Mailing Address - State: | MN |
| Mailing Address - Zip Code: | 55420-1013 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 612-235-7309 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 2910 PILLSBURY AVE S STE 131 |
| Practice Address - Street 2: | |
| Practice Address - City: | MINNEAPOLIS |
| Practice Address - State: | MN |
| Practice Address - Zip Code: | 55408-2335 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 612-229-4715 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2010-08-06 |
| Last Update Date: | 2010-08-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | |
| No | 302R00000X | Managed Care Organizations | Health Maintenance Organization | |
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
| No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
| No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | |
| No | 332100000X | Suppliers | Department of Veterans Affairs (VA) Pharmacy | |
| No | 332BC3200X | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
| No | 332BD1200X | Suppliers | Durable Medical Equipment & Medical Supplies | Dialysis Equipment & Supplies |
| No | 332BN1400X | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies |
| No | 332BP3500X | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition |
| No | 343800000X | Transportation Services | Secured Medical Transport (VAN) | |
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) |
