Provider Demographics
NPI:1972743318
Name:THE MEDICAL EQUIPMENT STORE LLC
Entity Type:Organization
Organization Name:THE MEDICAL EQUIPMENT STORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELUCA-RAHE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:859-322-8595
Mailing Address - Street 1:2040 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014-1210
Mailing Address - Country:US
Mailing Address - Phone:859-322-8595
Mailing Address - Fax:
Practice Address - Street 1:2040 MADISON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41014-1210
Practice Address - Country:US
Practice Address - Phone:859-322-8595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment