Provider Demographics
NPI:1508172073
Name:RESURGENT MEDICAL, LLC
Entity Type:Organization
Organization Name:RESURGENT MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY BOLESTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-314-6307
Mailing Address - Street 1:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-0634
Mailing Address - Country:US
Mailing Address - Phone:888-314-6307
Mailing Address - Fax:877-364-4421
Practice Address - Street 1:626 HANOVER PIKE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-2032
Practice Address - Country:US
Practice Address - Phone:888-314-6307
Practice Address - Fax:877-364-4421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06379827332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies