Healthcare Provider Details

I. General information

NPI: 1861426801
Provider Name (Legal Business Name): RITECARE MEDICAL SUPPLY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S GREENVILLE AVE STE 102
ALLEN TX
75002-3318
US

IV. Provider business mailing address

717 S GREENVILLE AVE STE 102
ALLEN TX
75002-3318
US

V. Phone/Fax

Practice location:
  • Phone: 972-396-0871
  • Fax: 972-396-2032
Mailing address:
  • Phone: 972-396-0871
  • Fax: 972-396-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0056215
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0056215
License Number StateTX

VIII. Authorized Official

Name: MR. MARTIN OLIVER ETIM
Title or Position: PRESIDENT/CEO
Credential:
Phone: 972-396-0871