Provider Demographics
NPI:1104823715
Name:RELIABLE MEDICAL PRODUCTS INC
Entity Type:Organization
Organization Name:RELIABLE MEDICAL PRODUCTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-434-5585
Mailing Address - Street 1:PO BOX 43965
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-3965
Mailing Address - Country:US
Mailing Address - Phone:623-434-5585
Mailing Address - Fax:623-434-5595
Practice Address - Street 1:301 W DEER VALLEY RD
Practice Address - Street 2:STE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2117
Practice Address - Country:US
Practice Address - Phone:623-434-5585
Practice Address - Fax:623-434-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-29
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-579814-D332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ442020Medicaid
AZ1267770001Medicare NSC