1730363631 NPI number — KRALL MEDICAL LLC

Table of content: (NPI 1730363631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730363631 NPI number — KRALL MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KRALL MEDICAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AT HOME MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730363631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1152 GILMORE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINONA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55987-2404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-453-9300
Provider Business Mailing Address Fax Number:
507-453-9612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1152 GILMORE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINONA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55987-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-453-9300
Provider Business Practice Location Address Fax Number:
507-453-9612
Provider Enumeration Date:
12/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRALL
Authorized Official First Name:
LYNDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
507-453-9300

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2324445 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 411817576 . This is a "MUTUAL OF OMAHA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 058835866 . This is a "AARP" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 105861 . This is a "CLEAR CONNECT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 411817576 . This is a "PHYSICIANS MUTUAL" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 41693800 . This is a "WISCONSIN MEDICAID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 63375 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 723336 . This is a "PREFFERED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 220717600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 411817576 . This is a "HUMANA GOLD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4BT93AT . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6G749AT . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 000750867 . This is a "APWU" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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