Provider Demographics
NPI:1558921692
Name:SYRACUSE HOME MEDICAL EQUIPMENT & SUPPLIES, LLC
Entity Type:Organization
Organization Name:SYRACUSE HOME MEDICAL EQUIPMENT & SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-363-1223
Mailing Address - Street 1:8124 BREWERTON RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9586
Mailing Address - Country:US
Mailing Address - Phone:315-363-1223
Mailing Address - Fax:
Practice Address - Street 1:8124 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9586
Practice Address - Country:US
Practice Address - Phone:315-363-1223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONNECT MEDICAL PRODUCTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies