MEDICARE: RSI 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972882959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RSI MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	2636 S LOOP W
Second Line	:	SUITE 675
City	:	HOUSTON
State	:	TX
Zip	:	77054-5638
Country	:	US
Telephone Number	:	713-440-7149
Fax Number	:

Provider Business Practice Location Address
First Line	:	2636 S LOOP W
Second Line	:	SUITE 675
City	:	HOUSTON
State	:	TX
Zip	:	77054-5638
Country	:	US
Telephone Number	:	713-440-7149
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JOE W. LUCERI
Credential	:
Telephone Number	:	314-447-7747

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	10/17/2012

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Directions to “RSI MEDICAL SUPPLY LLC ” Practice Location

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