Provider Demographics
NPI:1497072789
Name:RP MEDICAL SUPPLY
Entity Type:Organization
Organization Name:RP MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAFAELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-566-1340
Mailing Address - Street 1:8415 S 700 W
Mailing Address - Street 2:SUITE 20
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-6505
Mailing Address - Country:US
Mailing Address - Phone:801-566-1340
Mailing Address - Fax:
Practice Address - Street 1:8415 S 700 W
Practice Address - Street 2:SUITE 20
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-6505
Practice Address - Country:US
Practice Address - Phone:801-566-1340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6369620001Medicare NSC