NPIMap

Organization Active NPI

Rolseth Drug Co

  • Durable Medical Equipment & Medical Supplies
  • Forest Lake, MN
National Provider Identifier
1700812088
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
2003526 Issued in MN
Legal business name
ROLSETH DRUG CO
Practice address
107 Lake St N
Forest Lake, MN 55025-2504
Phone
(651) 464-2114
NPI assigned
Jun 25, 2006
Last updated
Feb 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

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

Authorized official

Name
Mr. Thomas R HaasNPI 1841819786
Title
Manager
Phone
(651) 464-2114

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X
Durable Medical Equipment & Medical Supplies 332B00000X 2003526 MN Primary
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

107 Lake St N
Forest Lake, MN 55025-2504

Mailing address

107 Lake St N
Forest Lake, MN 55025-2504
Phone (651) 464-2114

Other identifiers 1

IdentifierTypeStateIssuer
200760600MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930062887 MN DME Supplier - Pharmacy 1052438652 Practice locations: Forest Lake, MN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Rolseth Drug Co6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

107 Lake St N
Forest Lake, MN 55025
Phone (651) 464-2114

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1700812088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 LAKE ST N",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252504",
            "telephone_number": "651-464-2114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 LAKE ST N",
            "city": "FOREST LAKE",
            "state": "MN",
            "postal_code": "550252504",
            "telephone_number": "651-464-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROLSETH DRUG CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A",
        "authorized_official_last_name": "HAAS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "651-464-2114",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MN",
            "license": "2003526",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200760600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.