MEDICARE: RELIABLE MEDICAL SUPPLY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1437859188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIABLE MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	9495 WINNETKA AVE N STE 200
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-1618
Country	:	US
Telephone Number	:	629-282-8211
Fax Number	:	763-255-3972

Provider Business Practice Location Address
First Line	:	8249 PARKLINE BLVD STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7890
Country	:	US
Telephone Number	:	689-500-4455
Fax Number	:	689-610-6223

Authorized Official
Title or Position	:	SENIOR DIRECTOR OF PAYOR RELATIONS
Name	:	KILEY ANN RUSSELL
Credential	:
Telephone Number	:	629-252-8211

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	04/17/2024

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