Provider Demographics
NPI:1043605025
Name:BIRCH MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:BIRCH MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSING
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-563-8500
Mailing Address - Street 1:1017 E SOUTH BOULDER RD
Mailing Address - Street 2:STE A
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2563
Mailing Address - Country:US
Mailing Address - Phone:303-666-7746
Mailing Address - Fax:303-666-7746
Practice Address - Street 1:1017 E SOUTH BOULDER RD
Practice Address - Street 2:STE A
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2563
Practice Address - Country:US
Practice Address - Phone:303-666-7746
Practice Address - Fax:303-666-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies