Provider Demographics
NPI:1720327265
Name:REDTAIL SUPPLY CORPORATION DBA AMRAMP
Entity Type:Organization
Organization Name:REDTAIL SUPPLY CORPORATION DBA AMRAMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALLENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CSA
Authorized Official - Phone:208-371-1258
Mailing Address - Street 1:2375 S COBALT POINT WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8029
Mailing Address - Country:US
Mailing Address - Phone:208-371-1258
Mailing Address - Fax:208-350-7271
Practice Address - Street 1:2375 S COBALT POINT WAY STE 102
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8029
Practice Address - Country:US
Practice Address - Phone:208-371-1258
Practice Address - Fax:208-350-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies