Provider Demographics
NPI:1598991135
Name:RELIABLE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:RELIABLE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:GERALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-212-1300
Mailing Address - Street 1:28455 HAGGERTY RD STE 201
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2982
Mailing Address - Country:US
Mailing Address - Phone:248-994-3141
Mailing Address - Fax:248-994-0887
Practice Address - Street 1:28455 HAGGERTY RD STE 201
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2982
Practice Address - Country:US
Practice Address - Phone:248-994-3141
Practice Address - Fax:248-994-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F38945OtherBLUE CROSS BLUE SHIELD
MI0F38945OtherBLUE CROSS BLUE SHIELD