MEDICARE: RYDALE MEDICAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	NONE REQUIRED	NE
2	332BN1400X	Nursing Facility Supplies (DME)	NONE REQUIRED	NE
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	NONE REQUIRED	NE
4	332BX2000X	Oxygen Equipment & Supplies (DME)	NONE REQUIRED	NE
5	332BD1200X	Dialysis Equipment & Supplies (DME)	NONE REQUIRED	NE
6	332S00000X	Hearing Aid Equipment	NONE REQUIRED	NE
7	335E00000X	Prosthetic/Orthotic Supplier	NONE REQUIRED	NE
8	332U00000X	Home Delivered Meals	NONE REQUIRED	NE
9	332B00000X	Durable Medical Equipment & Medical Supplies	NONE REQUIRED	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	D09862	OTHER	NE	BCBS NE

General Provider Information

NPI Number	:	1326013749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYDALE MEDICAL, INC.

Provider Business Mailing Address
First Line	:	16909 LAKESIDE HILLS PLZ
Second Line	:	SUITE 108
City	:	OMAHA
State	:	NE
Zip	:	68130-4654
Country	:	US
Telephone Number	:	402-697-3949
Fax Number	:	402-697-3950

Provider Business Practice Location Address
First Line	:	16909 LAKESIDE HILLS PLZ
Second Line	:	SUITE 108
City	:	OMAHA
State	:	NE
Zip	:	68130-4654
Country	:	US
Telephone Number	:	402-697-3949
Fax Number	:	402-697-3950

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LINDA D GOODLETT
Credential	:
Telephone Number	:	402-697-3949

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	11/28/2007

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Directions to “RYDALE MEDICAL, INC. ” Practice Location

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