Healthcare Provider Details

I. General information

NPI: 1326013749
Provider Name (Legal Business Name): RYDALE MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16909 LAKESIDE HILLS PLZ SUITE 108
OMAHA NE
68130-4654
US

IV. Provider business mailing address

16909 LAKESIDE HILLS PLZ SUITE 108
OMAHA NE
68130-4654
US

V. Phone/Fax

Practice location:
  • Phone: 402-697-3949
  • Fax: 402-697-3950
Mailing address:
  • Phone: 402-697-3949
  • Fax: 402-697-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNONE REQUIRED
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberNONE REQUIRED
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License NumberNONE REQUIRED
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberNONE REQUIRED
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberNONE REQUIRED
License Number StateNE
# 6
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberNONE REQUIRED
License Number StateNE
# 7
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberNONE REQUIRED
License Number StateNE
# 8
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License NumberNONE REQUIRED
License Number StateNE
# 9
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberNONE REQUIRED
License Number StateNE

VIII. Authorized Official

Name: MRS. LINDA D GOODLETT
Title or Position: PRESIDENT
Credential:
Phone: 402-697-3949