Healthcare Provider Details

I. General information

NPI: 1023630472
Provider Name (Legal Business Name): RELIABLE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 E KEMPER RD
SHARONVILLE OH
45241-1800
US

IV. Provider business mailing address

9495 WINNETKA AVE N STE 200
MINNEAPOLIS MN
55445-1618
US

V. Phone/Fax

Practice location:
  • Phone: 513-392-5044
  • Fax: 800-878-2799
Mailing address:
  • Phone: 629-282-8211
  • Fax: 763-255-3972

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

VIII. Authorized Official

Name: KILEY RUSSELL
Title or Position: SENIOR DIRECTOR OF PAYOR RELATIONS
Credential:
Phone: 629-252-8211