Provider Demographics
NPI:1528146461
Name:AT HOME MEDICAL SUPPLY
Entity type:Organization
Organization Name:AT HOME MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-453-9300
Mailing Address - Street 1:1152 GILMORE AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-2404
Mailing Address - Country:US
Mailing Address - Phone:507-453-9300
Mailing Address - Fax:
Practice Address - Street 1:1152 GILMORE AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-2404
Practice Address - Country:US
Practice Address - Phone:507-453-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2324445332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN105861OtherCLEAR CONNECT
MN63375OtherHEALTH PARTNERS
MN41693800OtherWISCONSIN MEDICAID
MN6G749ATOtherBCBS
MN723336OtherPREFFERED ONE
MN=========OtherMUTUAL OF OMAHA
MN=========OtherHUMANA GOLD
MN=========OtherPHYSICIANS MUTUAL
MN41693800OtherWISCONSIN MEDICAID