Idimo Medical Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

IDIMO MEDICAL SUPPLY

Practice address

151 Silver Lake Rd NW
Suite 1B
New Brighton, MN 55112-3162

Phone

(651) 639-1400

Fax

(651) 639-1401

NPI assigned

Jul 2, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Stephen Idem Etuko

Title

Director

Phone

(651) 639-1400

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790714566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SILVER LAKE RD NW",
            "address_2": "SUITE 1B",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551123162",
            "telephone_number": "651-639-1400",
            "fax_number": "651-639-1401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 SILVER LAKE RD NW",
            "address_2": "SUITE 1B",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551123162",
            "telephone_number": "651-639-1400",
            "fax_number": "651-639-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDIMO MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ETUKO",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "IDEM",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "651-639-1400",
        "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": []
}

• Loren Paul Hubin, PHD
• Rachel Rose Hulkonen, PSY.D., L.P.
• Scot Montgomery Hunter, MA, LP
• Brianna Hursey, RBT
• Khadra Ibrahim
• Stacey Ann Ihle, M.A.,CCC-SLP
• Integrated Body Therapies, Inc.
• Megan Christine Isaacs, PTA
• Isd 621
• Abdirisak Ismail

• Durable Medical Equipment & Medical Supplies in New Brighton, MN
• Providers in New Brighton, 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 Aug 22, 2020; 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.