Provider Demographics
NPI:1831386937
Name:REDBIRD MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:REDBIRD MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:WIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-776-3184
Mailing Address - Street 1:12050 TAMA RUN LN
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-9627
Mailing Address - Country:US
Mailing Address - Phone:608-776-3184
Mailing Address - Fax:608-776-3987
Practice Address - Street 1:12050 TAMA RUN LN
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-9627
Practice Address - Country:US
Practice Address - Phone:608-776-3184
Practice Address - Fax:608-776-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies