Provider Demographics
NPI:1629558010
Name:RICK'S MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:RICK'S MEDICAL SUPPLY, INC
Other - Org Name:SUPERCARE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-260-2550
Mailing Address - Street 1:8345 FIRESTONE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-3871
Mailing Address - Country:US
Mailing Address - Phone:888-260-2550
Mailing Address - Fax:
Practice Address - Street 1:1934 NEWMARK ST STE C
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-1274
Practice Address - Country:US
Practice Address - Phone:541-672-3042
Practice Address - Fax:541-673-0715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR164590Medicaid