NPIMap

Organization Active NPI

Providacare Medical Supply LTD

  • Durable Medical Equipment & Medical Supplies
  • Duluth, MN
National Provider Identifier
1386895746
Registry record updated Jan 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PROVIDACARE MEDICAL SUPPLY LTD
Practice address
831 E 2ND St
Duluth, MN 55805-2103
Phone
(218) 727-5555
Fax
(218) 727-9999
NPI assigned
Oct 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2009

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

Authorized official

Name
Mr. Adam Wayne Blumenshein
Title
Partner
Phone
(512) 733-6518

Specialties & licenses 1

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

Addresses

Primary practice location

831 E 2ND St
Duluth, MN 55805-2103

Mailing address

3721 Executive Center Dr
Suite 102
Austin, TX 78731-1645
Phone (512) 733-6518

National Provider Directory

National Provider Directory
Tax ID family
Providacare Medical Supply LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233273600000",
    "number": "1386895746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3721 EXECUTIVE CENTER DR",
            "address_2": "SUITE 102",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787311645",
            "telephone_number": "512-733-6518",
            "fax_number": "512-795-9185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052103",
            "telephone_number": "218-727-5555",
            "fax_number": "218-727-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDACARE MEDICAL SUPPLY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-03",
        "last_updated": "2009-01-30",
        "status": "A",
        "authorized_official_last_name": "BLUMENSHEIN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "512-733-6518",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2009; 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.