DIABETIC SHOE SOURCE (NPI# 1003960147) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003960147 |
| Entity Type | Organization |
| Organization Name | DIABETIC SHOE SOURCE |
| Practice Address |
7362 University Ave Ne Suite 306 Fridley MN 55432-3142 |
| Practice Telephone | 7637578086 |
| Practice Fax Number | 7638624797 |
| Mailing Telephone | 7637578086 |
| Mailing Fax Number | 7638624797 |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2015-03-10 |
| Authorized Official Name | MARK AHLGREN (PRESIDENT) |
| Authorized Official Telephone | 7637578086 |
| Authorized Official Credential | C. PED. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | BCBS | 786A6DI | 01 |
| MN | 520052200 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396168290 | Diabetic Shoe Source | Durable Medical Equipment & Medical Supplies | 104 Mcauley Dr, Vicksburg, MS 39183-2825 | 2014-01-28 |
| Street Address |
7362 UNIVERSITY AVE NE SUITE 306 |
| City | FRIDLEY |
| State | MN |
| Zip Code | 55432-3142 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538160064 | Norman Paul Reznicow | Optometrist | 7362 University Ave Ne, Fridley, MN 55432-3151 | 2005-08-09 |
| 1740769108 | Origin Home Care and PCa Agency, LLC | In Home Supportive Care | 7362 University Ave Ne, Fridley, MN 55432 | 2018-08-07 |
| 1154852663 | Right Mind Counseling Services, Pllc | Social Worker | 7362 University Ave Ne, Suite 101, Fridley, MN 55432-3142 | 2017-03-26 |
| 1154751352 | Emily Gail Erickson | Marriage & Family Therapist | 7362 University Ave Ne, Fridley, MN 55432-3142 | 2013-11-25 |
| 1356671267 | Metro Vein Clinic, Pa | Internal Medicine | 7362 University Ave Ne, Ste 201, Fridley, MN 55432-3142 | 2009-12-29 |
| 1275767378 | Judy Joann Johnson | Technician/Technologist | 7362 University Ave Ne, 206, Fridley, MN 55432-3142 | 2009-05-05 |
| 1477732154 | Integrity Health Care Services | Home Health | 7362 University Ave Ne, 303, Fridley, MN 55432-3142 | 2007-10-30 |
| 1801090055 | Lisa C Kastenbauer | Marriage & Family Therapist | 7362 University Ave Ne, 302, Fridley, MN 55432-3142 | 2007-06-12 |
| 1528103595 | Gene M Nisja | Marriage & Family Therapist | 7362 University Ave Ne, Suite 209, Fridley, MN 55432-3142 | 2007-02-20 |
| 1225138084 | Thomas Edward Harbaugh | Psychologist | 7362 University Ave Ne, Suite 209, Fridley, MN 55432-3142 | 2006-09-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336791177 | Adelyn Ruth Kopp | Occupational Therapist | 500 Osborne Rd Ne Suite 365, Fridley, MN 55432 | 2019-07-11 |
| 1831665603 | White Smiles Family Dentistry Pllc | Dentist | 1611 County Hwy 10, Minneapolis, MN 55432 | 2018-10-19 |
| 1518402213 | Peaceful Adult Day Center LLC. | Home Health | 6267 University Ave Ne, Fridley, MN 55432 | 2017-01-04 |
| 1205383742 | Farhiya Mahamud Gelle I | Durable Medical Equipment & Medical Supplies | 6329 5th Street Ne Apt 8, Fridley, MN 55432 | 2016-09-01 |
| 1093163164 | Christiane Schwecke | Specialist/Technologist | 8290 University Ave N, Fridley, MN 55432 | 2016-05-31 |
| 1336551563 | Amy White Mountain | Massage Therapist | 1611 County Hwy 10 Ne, Spring Lake Park, MN 55432 | 2014-05-22 |
| 1942629795 | Shane O'neil | Dermatology | 500 Osborne Rd Ne Ste 330, Fridley, MN 55432 | 2014-04-09 |
| 1952648180 | John Franklyn Marshall | Family Medicine | 480 Osborne Road Ne, Suite 100, Fridley, MN 55432 | 2013-01-08 |
| 1558610519 | Novacare Outpatient Rehabilitation East Inc | Clinic/Center | 480 Osborne Road, Number 280, Fridley, MN 55432 | 2012-09-06 |
| 1336423391 | Christian Restoration Services | Counselor | 7157 Commerce Circle W, Fridley, MN 55432 | 2011-10-07 |
| Find all providers in zip 55432 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205383742 | Farhiya Mahamud Gelle I | Durable Medical Equipment & Medical Supplies | 6329 5th Street Ne Apt 8, Fridley, MN 55432 | 2016-09-01 |
| 1659732360 | Independent Living Solutions | Durable Medical Equipment & Medical Supplies | 7714 Beech St Ne, Fridley, MN 55432-2512 | 2016-03-09 |
| 1609261809 | Corner Medical LLC | Durable Medical Equipment & Medical Supplies | 1270 Moore Lake Dr E, Fridley, MN 55432-5170 | 2015-04-03 |
| 1750546123 | Rehabtech Inc. | Durable Medical Equipment & Medical Supplies | 7142 University Ave Ne, Fridley, MN 55432-3100 | 2008-07-24 |
| 1063620672 | Novacare Outpatient Rehabilitation East Inc | Durable Medical Equipment & Medical Supplies | 8290 University Avenue Nw, Suite 300, Fridley, MN 55432 | 2007-05-18 |
| 1851461792 | Grand St Paul Cvs LLC | Durable Medical Equipment & Medical Supplies | 5696 University Ave Ne, Fridley, MN 55432-5579 | 2006-11-08 |
| 1831204973 | Supervalu Pharmacies Inc | Durable Medical Equipment & Medical Supplies | 246 57th Ave Ne, Fridley, MN 55432 | 2006-08-20 |
| 1275550675 | Sams West Inc | Durable Medical Equipment & Medical Supplies | 8150 University Ave Ne, Fridley, MN 55432-1864 | 2006-07-16 |
| 1225077928 | Allina Health System | Durable Medical Equipment & Medical Supplies | 550 Osborne Rd Ne Rm Ll0222, Fridley, MN 55432-2718 | 2006-06-06 |
| 1346237542 | Kci Usa, Inc. | Durable Medical Equipment & Medical Supplies | 7217 University Ave Ne, Fridley, MN 55432 | 2005-10-03 |
| Find all providers in FRIDLEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.