Healthcare Provider Details

I. General information

NPI: 1295542991
Provider Name (Legal Business Name): RELIANT SUPPLY GROUP, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1869 CRAIG PARK CT
SAINT LOUIS MO
63146-4122
US

IV. Provider business mailing address

1869 CRAIG PARK CT
SAINT LOUIS MO
63146-4122
US

V. Phone/Fax

Practice location:
  • Phone: 314-682-5368
  • Fax: 314-226-1736
Mailing address:
  • Phone: 314-682-5368
  • Fax: 314-226-1736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD J. DESTEFANE
Title or Position: MANAGER
Credential:
Phone: 314-682-5368