Provider Demographics
NPI:1437204591
Name:REDI-MEDICAL, INC.
Entity Type:Organization
Organization Name:REDI-MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-668-7334
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-0106
Mailing Address - Country:US
Mailing Address - Phone:410-668-7334
Mailing Address - Fax:410-668-8093
Practice Address - Street 1:2527 PUTTY HILL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-4307
Practice Address - Country:US
Practice Address - Phone:410-668-7334
Practice Address - Fax:410-668-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2152332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD364008600Medicaid
MD6902000000Y097OtherCAREFIRST NASCO OF MD
MDY097REOtherCAREFIRST BCBSMD
MD53330102OtherCAREFIRST BCBS OF MD
MD=========OtherGENERIC ID NUMBER