Provider Demographics
NPI:1609546621
Name:RELIANT MEDICAL SUPPLIER LLC
Entity Type:Organization
Organization Name:RELIANT MEDICAL SUPPLIER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-241-6001
Mailing Address - Street 1:105 EDGEWOOD PLAZA DR STE C
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1863
Mailing Address - Country:US
Mailing Address - Phone:859-241-6001
Mailing Address - Fax:859-241-6049
Practice Address - Street 1:105 EDGEWOOD PLAZA DR STE C
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1863
Practice Address - Country:US
Practice Address - Phone:859-241-6001
Practice Address - Fax:859-241-6049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies