Provider Demographics
NPI:1932566650
Name:RELIANT MEDICAL LLC
Entity Type:Organization
Organization Name:RELIANT MEDICAL LLC
Other - Org Name:RELIANT HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-322-8326
Mailing Address - Street 1:PO BOX 14813
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71207-4813
Mailing Address - Country:US
Mailing Address - Phone:877-354-2688
Mailing Address - Fax:888-972-9703
Practice Address - Street 1:4315 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3024
Practice Address - Country:US
Practice Address - Phone:877-354-2688
Practice Address - Fax:888-972-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy