| NPI | 1023254216 |
|---|---|
| Doing Business As | PROVIDACARE MEDICAL SUPPLY |
| Entity Type | Organization |
| Authorized Contact | JAMES M SHANDORF CEO 218-727-5555 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2019-01-29 |