Healthcare Provider Details

I. General information

NPI: 1932330537
Provider Name (Legal Business Name): REEDLEY MEDICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 11TH ST
REEDLEY CA
93654-2924
US

IV. Provider business mailing address

1205 11TH ST
REEDLEY CA
93654-2924
US

V. Phone/Fax

Practice location:
  • Phone: 559-638-8004
  • Fax: 559-637-1979
Mailing address:
  • Phone: 559-638-8004
  • Fax: 559-637-1979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. RHODA ENNS
Title or Position: PRESIDENT / CEO
Credential:
Phone: 559-638-8004