Provider Demographics
NPI:1407251648
Name:RSD MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:RSD MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:ALISON
Authorized Official - Last Name:BOCATCAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-352-2102
Mailing Address - Street 1:136 N LA GRANGE RD
Mailing Address - Street 2:STE A
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2059
Mailing Address - Country:US
Mailing Address - Phone:708-352-2101
Mailing Address - Fax:708-352-2103
Practice Address - Street 1:136 N LA GRANGE RD
Practice Address - Street 2:STE A
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-2059
Practice Address - Country:US
Practice Address - Phone:708-352-2101
Practice Address - Fax:708-352-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies