Provider Demographics
NPI:1477739571
Name:RNC MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:RNC MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HERMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-342-1300
Mailing Address - Street 1:PO BOX 566
Mailing Address - Street 2:9437 CHURCH ST
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649
Mailing Address - Country:US
Mailing Address - Phone:231-342-1300
Mailing Address - Fax:231-263-0222
Practice Address - Street 1:9437 CHURCH ST
Practice Address - Street 2:
Practice Address - City:KINGSLEY
Practice Address - State:MI
Practice Address - Zip Code:49649
Practice Address - Country:US
Practice Address - Phone:231-342-1300
Practice Address - Fax:231-263-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHTR2334559332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIHTR2334559Medicaid