Provider Demographics
NPI:1811082332
Name:TONKA MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:TONKA MEDICAL SUPPLIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DMITRUK
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:612-285-3448
Mailing Address - Street 1:8110 MINNETONKA BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3022
Mailing Address - Country:US
Mailing Address - Phone:952-939-1171
Mailing Address - Fax:952-939-0183
Practice Address - Street 1:8110 MINNETONKA BLVD.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3022
Practice Address - Country:US
Practice Address - Phone:952-939-1171
Practice Address - Fax:952-939-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN069258332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1811082332Medicaid
MN8200111OtherMEDICA PROVIDER NUMBER
MN8214407OtherMEDICA PROVIDER NUMBER
MN448816400Medicaid
MN115818OtherUCARE PROVIDER NUMBER
MN8200868OtherMEDICA PROVIDER NUMBER
MN8G640TOOtherBLUECROSS BLUESHIELD
MN448816400Medicaid