Provider Demographics
NPI:1013527290
Name:RIPTIDE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:RIPTIDE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-621-4014
Mailing Address - Street 1:355 W ELIZABETH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-5626
Mailing Address - Country:US
Mailing Address - Phone:956-621-4014
Mailing Address - Fax:855-494-1583
Practice Address - Street 1:355 W ELIZABETH ST STE 130
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-5626
Practice Address - Country:US
Practice Address - Phone:956-621-4014
Practice Address - Fax:855-494-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies