Proficio Ancillary Service Provider, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PROFICIO ANCILLARY SERVICE PROVIDER, LLC

Practice address

4445 W 77TH St Ste 208
Edina, MN 55435-5190

Phone

(952) 562-2900

Fax

(248) 487-9442

NPI assigned

Apr 18, 2023

Organization subpart

No

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

Authorized official

Name

Bruce Capagli

Title

Coo

Phone

(952) 562-2900

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1366139768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7455 FRANCE AVE S STE 373",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 W 77TH ST STE 208",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355190",
            "telephone_number": "952-562-2900",
            "fax_number": "248-487-9442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFICIO ANCILLARY SERVICE PROVIDER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-18",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A",
        "authorized_official_last_name": "CAPAGLI",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "952-562-2900"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347E00000X",
            "taxonomy_group": "",
            "desc": "Transportation Broker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Edina, MN
• Providers in Edina, MN by specialty
• Durable Medical Equipment & Medical Supplies in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; 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.