1649349341 NPI number — RANDLES MEDICAL SUPPLIES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649349341 NPI number — RANDLES MEDICAL SUPPLIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDLES MEDICAL SUPPLIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649349341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
838 OTSEGO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COSHOCTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43812-2545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-622-8365
Provider Business Mailing Address Fax Number:
740-622-0801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
838 OTSEGO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COSHOCTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43812-2545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-622-8365
Provider Business Practice Location Address Fax Number:
740-622-0801
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RANDLES
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
740-622-8365

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0144712 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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