Provider Demographics
NPI:1114080470
Name:REEDLEY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:REEDLEY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHODA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-638-8004
Mailing Address - Street 1:1205 11TH ST
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-2924
Mailing Address - Country:US
Mailing Address - Phone:559-638-8004
Mailing Address - Fax:559-637-1979
Practice Address - Street 1:1205 11TH ST
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-2924
Practice Address - Country:US
Practice Address - Phone:559-638-8004
Practice Address - Fax:559-637-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00898FMedicaid
CA0307220001Medicare NSC