| NPI | 1538233978 |
|---|---|
| Doing Business As | PROVIDACARE MEDICAL SUPPLY |
| Entity Type | Organization |
| Authorized Contact | JAMES M SHANDORF CEO 651-387-0376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BX2000X Durable Medical Equipment & Medical Supplies Oxygen Equipment & Supplies (Licence: MN 17042572) |
| Enumeration Date | 2006-11-18 |
| Last Update Date | 2019-01-24 |