=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811749534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RX MEDICAL SUPPLIES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2024
-----------------------------------------------------
Last Update Date | 04/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 MANZANITA AVE STE B6
-----------------------------------------------------
City | CARMICHAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95608-0911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-209-9878
-----------------------------------------------------
Fax | 916-299-5231
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 MANZANITA AVE STE B6
-----------------------------------------------------
City | CARMICHAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95608-0911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-209-9878
-----------------------------------------------------
Fax | 916-299-5231
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | JAMES ANTHONY LEWIS II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-209-9878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------