Provider Demographics
NPI:1386890408
Name:MINIMED DISTRIBUTION CORP.
Entity type:Organization
Organization Name:MINIMED DISTRIBUTION CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OPERATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-550-2017
Mailing Address - Street 1:18000 DEVONSHIRE ST
Mailing Address - Street 2:ATTN: MANAGED MARKETS
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1219
Mailing Address - Country:US
Mailing Address - Phone:800-646-4633
Mailing Address - Fax:818-739-4843
Practice Address - Street 1:14420 NW 60TH AVE BLDG 7B
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2807
Practice Address - Country:US
Practice Address - Phone:800-646-4633
Practice Address - Fax:818-739-4414
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINIMED DISTRIBUTION CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-08
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL952036800Medicaid