MEDICARE: ROADRUNNER HOME MEDICAL EQUIPMENT,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	03-002816-00-7	NM

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	:	1689639395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROADRUNNER HOME MEDICAL EQUIPMENT,LLC

Provider Business Mailing Address
First Line	:	2429 QUINCY ST NE STE D
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4074
Country	:	US
Telephone Number	:	505-872-1352
Fax Number	:	505-872-1354

Provider Business Practice Location Address
First Line	:	2429 QUINCY ST NE STE D
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4074
Country	:	US
Telephone Number	:	505-872-1352
Fax Number	:	505-872-1354

Authorized Official
Title or Position	:	OWNER
Name	:	SHERRY WILLIAMS
Credential	:
Telephone Number	:	505-872-1352

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	01/11/2012

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