Provider Demographics
NPI:1518945096
Name:RCC MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:RCC MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-356-9078
Mailing Address - Street 1:3109 35TH AVE
Mailing Address - Street 2:STE C
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9475
Mailing Address - Country:US
Mailing Address - Phone:970-356-9078
Mailing Address - Fax:970-330-2087
Practice Address - Street 1:3109 35TH AVE
Practice Address - Street 2:STE C
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-9475
Practice Address - Country:US
Practice Address - Phone:970-356-9078
Practice Address - Fax:970-330-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99086271Medicaid
CO99086271Medicaid