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General NPI Number Information
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NPI Number | 1396202495
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Entity Type | Organization
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Legal Business Name | RUCKER HOLDINGS
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Dates
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Enumeration Date | 02/25/2019
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 210 GRAND CENTRAL BLVD
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City | POOLER
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State | GA
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Zip | 31322
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Country | US
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Telephone | 912-877-3202
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Fax |
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Provider Business Mailing Address
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Address Line | 481 ELMA G MILES PKWY STE B
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City | HINESVILLE
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State | GA
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Zip | 31313-4004
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Country | US
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Telephone | 912-877-3202
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Fax | 912-877-3206
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Authorized Official
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Title or Position | CEO
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Name | MRS. KRISTINA RUCKER
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Credential |
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Telephone | 912-877-3202
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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