MEDICARE: RICK'S MEDICAL SUPPLY, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

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

General Provider Information

NPI Number	:	1629558010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICK'S MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	16017 VALLEY BLVD.
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91744-5424
Country	:	US
Telephone Number	:	888-260-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	1934 NEWMARK ST STE C
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-1274
Country	:	US
Telephone Number	:	541-672-3042
Fax Number	:	541-673-0715

Authorized Official
Title or Position	:	CEO
Name	:	JOHN CASSAR
Credential	:
Telephone Number	:	888-260-2550

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	03/20/2026

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