Provider Demographics
NPI:1164446506
Name:RUXTON SUPPLY SERVICES, LLC
Entity Type:Organization
Organization Name:RUXTON SUPPLY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EAMONN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-715-8900
Mailing Address - Street 1:10420 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3533
Mailing Address - Country:US
Mailing Address - Phone:410-884-6844
Mailing Address - Fax:410-715-8786
Practice Address - Street 1:10420 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3533
Practice Address - Country:US
Practice Address - Phone:410-884-6844
Practice Address - Fax:410-715-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010257921Medicaid
MD407330400Medicaid
5386850001Medicare NSC