Provider Demographics
NPI:1528560786
Name:DOUGLAS RASNAKE
Entity Type:Organization
Organization Name:DOUGLAS RASNAKE
Other - Org Name:DOUGLAS RASNAKE MEDICAL SUPPLY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:RASNAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-698-4272
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-1148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1148
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-1148
Practice Address - Country:US
Practice Address - Phone:276-698-4272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGLAS RASNAKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies