Provider Demographics
NPI:1902063381
Name:MINIMED DISTRIBUTION CORP
Entity Type:Organization
Organization Name:MINIMED DISTRIBUTION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR PAYER RELATIONS ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-576-5728
Mailing Address - Street 1:18000 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1219
Mailing Address - Country:US
Mailing Address - Phone:804-262-6492
Mailing Address - Fax:818-576-6228
Practice Address - Street 1:3555 KOGER BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-7624
Practice Address - Country:US
Practice Address - Phone:800-646-4633
Practice Address - Fax:818-739-4843
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINIMED DISTRIBUTION CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003279549AMedicaid