Provider Demographics
NPI:1144520297
Name:HEALTHNORTH MEDICAL SUPPLY COMPANY
Entity type:Organization
Organization Name:HEALTHNORTH MEDICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-260-5280
Mailing Address - Street 1:165 19TH ST S
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4773
Mailing Address - Country:US
Mailing Address - Phone:320-281-5311
Mailing Address - Fax:320-281-5318
Practice Address - Street 1:165 19TH ST S
Practice Address - Street 2:SUITE 104
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4773
Practice Address - Country:US
Practice Address - Phone:320-281-5311
Practice Address - Fax:320-281-5318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies