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General NPI Number Information
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NPI Number | 1023436615
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Entity Type | Organization
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Legal Business Name | REVOLUTIONARY MEDICAL SUPPLIES LLC
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 450 VAN PELT LN
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City | PENSACOLA
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State | FL
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Zip | 32505-2532
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Country | US
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Telephone | 850-777-1213
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Fax | 850-478-1864
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Provider Business Mailing Address
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Address Line | 7465 N PALAFOX ST
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City | PENSACOLA
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State | FL
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Zip | 32503-7077
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Country | US
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Telephone | 850-777-1213
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Fax | 850-478-1864
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MISS BRENDA DAWN HADDEN
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Credential | RN
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Telephone | 850-777-1213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 685961
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License Number State | FL
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