Provider Demographics
NPI:1316198633
Name:RANCER L. HUNTINGTON
Entity Type:Organization
Organization Name:RANCER L. HUNTINGTON
Other - Org Name:STATELINE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RANCER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-488-0618
Mailing Address - Street 1:1090 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1902
Mailing Address - Country:US
Mailing Address - Phone:765-488-0618
Mailing Address - Fax:765-488-1916
Practice Address - Street 1:1090 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1902
Practice Address - Country:US
Practice Address - Phone:765-488-0618
Practice Address - Fax:765-488-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200945740AMedicaid
IN6214680001Medicare NSC