Provider Demographics
NPI:1366693202
Name:RELIANT MEDICAL LLC
Entity Type:Organization
Organization Name:RELIANT MEDICAL LLC
Other - Org Name:RELIANT HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-322-8326
Mailing Address - Street 1:PO BOX 2293
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71207-2293
Mailing Address - Country:US
Mailing Address - Phone:318-322-8326
Mailing Address - Fax:318-322-0998
Practice Address - Street 1:1004 N 19TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5734
Practice Address - Country:US
Practice Address - Phone:318-322-8326
Practice Address - Fax:318-322-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336H0001X
LA37-0012056332BX2000X
LA6054IR3336C0003X
LA60543336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1934125OtherNCPDP PROVIDER IDENTIFICATION NUMBER
LA1234354Medicaid
6161630001Medicare NSC