Healthcare Provider Details

I. General information

NPI: 1376542019
Provider Name (Legal Business Name): REMKE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL VILLAGE DR SUITE 103
EDGEWOOD KY
41017-5401
US

IV. Provider business mailing address

20 MEDICAL VILLAGE DR SUITE 103
EDGEWOOD KY
41017-5401
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-3456
  • Fax: 859-341-3585
Mailing address:
  • Phone: 859-341-3456
  • Fax: 859-341-3585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMG0479
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberMG0479
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberMG0479
License Number StateKY

VIII. Authorized Official

Name: MR. WILLIAM HENRY REMKE
Title or Position: PRESIDENT
Credential:
Phone: 859-341-3456