NPIMap

Organization Active NPI

Minimed Distribution Corp.

  • Durable Medical Equipment & Medical Supplies
  • Memphis, TN
National Provider Identifier
1124213855
Registry record updated Jan 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
611 Issued in TN
Legal business name
MINIMED DISTRIBUTION CORP.
Practice address
1800 Pyramid PL
Memphis, TN 38132-1703
Phone
(800) 646-4633
Fax
(818) 739-4414
NPI assigned
Sep 6, 2007
Organization subpart
Yes
Parent organization
MEDTRONIC MINIMEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessica Puathasnanon
Title
Chief Counsel
Phone
(804) 550-2017

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 611 TN Primary

Addresses

Primary practice location

1800 Pyramid PL
Memphis, TN 38132-1703

Mailing address

18000 Devonshire St
Attn: Angela Ward - Legal Dept
Northridge, CA 91325-1219
Phone (800) 933-3322

Other identifiers 2

IdentifierTypeStateIssuer
137682716MedicaidAR
1454129MedicaidTN

National Provider Directory

National Provider Directory
Tax ID family
Minimed Distribution Corp18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515456000000",
    "number": "1124213855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18000 DEVONSHIRE ST",
            "address_2": "ATTN: ANGELA WARD - LEGAL DEPT",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251219",
            "telephone_number": "800-933-3322",
            "fax_number": "818-576-6228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 PYRAMID PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381321703",
            "telephone_number": "800-646-4633",
            "fax_number": "818-739-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINIMED DISTRIBUTION CORP.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDTRONIC MINIMED",
        "enumeration_date": "2007-09-06",
        "last_updated": "2018-01-09",
        "status": "A",
        "authorized_official_last_name": "PUATHASNANON",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "CHIEF COUNSEL",
        "authorized_official_telephone_number": "804-550-2017"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TN",
            "license": "611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137682716",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1454129",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.