Provider Demographics
NPI:1336685338
Name:RED MOUNTAIN MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:RED MOUNTAIN MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PINNACLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANAGEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-300-4864
Mailing Address - Street 1:3422 OLD CAPITOL TRL
Mailing Address - Street 2:SUITE 350-E
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6124
Mailing Address - Country:US
Mailing Address - Phone:302-300-4864
Mailing Address - Fax:
Practice Address - Street 1:3422 OLD CAPITOL TRL
Practice Address - Street 2:SUITE 350-E
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-6124
Practice Address - Country:US
Practice Address - Phone:302-300-4864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies