Provider Demographics
NPI:1225088974
Name:RUONALA DURABLE MEDICAL EQUIPMENT INC.
Entity Type:Organization
Organization Name:RUONALA DURABLE MEDICAL EQUIPMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RUONALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-249-2722
Mailing Address - Street 1:423 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-3023
Mailing Address - Country:US
Mailing Address - Phone:843-249-2722
Mailing Address - Fax:843-249-7522
Practice Address - Street 1:423 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3023
Practice Address - Country:US
Practice Address - Phone:843-249-2722
Practice Address - Fax:843-249-7522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26556076332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2390Medicaid
NC7704275Medicaid
NC7704275Medicaid