Provider Demographics
NPI:1780915439
Name:REDLINE DISTRIBUTORS
Entity type:Organization
Organization Name:REDLINE DISTRIBUTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNNER
Authorized Official - Prefix:
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:EZEKIEL
Authorized Official - Last Name:DELOLMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-261-3049
Mailing Address - Street 1:PO BOX 12567
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-0567
Mailing Address - Country:US
Mailing Address - Phone:915-261-3049
Mailing Address - Fax:915-875-0890
Practice Address - Street 1:421 STOTTS AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-2229
Practice Address - Country:US
Practice Address - Phone:915-261-3049
Practice Address - Fax:915-875-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment