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General NPI Number Information
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NPI Number | 1982606851
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Entity Type | Organization
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Legal Business Name | RENAISSANCE MEDICAL LLC
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 4530 BISHOP LN SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40218-4561
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Country | US
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Telephone | 502-961-8560
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Fax | 606-878-1862
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Provider Business Mailing Address
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Address Line | 1380 W 5TH ST
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City | LONDON
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State | KY
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Zip | 40741-1615
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Country | US
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Telephone | 606-878-0453
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Fax | 606-878-1862
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAMES C GRAHAM
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Credential | RRT
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Telephone | 606-878-0453
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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 | HME00021
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License Number State | KY
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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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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | MG0190
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License Number State | KY
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