Provider Demographics
NPI:1679578694
Name:RELIABLE MEDICAL SUPPLY & RENTAL, INC.
Entity type:Organization
Organization Name:RELIABLE MEDICAL SUPPLY & RENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-784-2580
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:KS
Mailing Address - Zip Code:67330-0008
Mailing Address - Country:US
Mailing Address - Phone:620-784-2580
Mailing Address - Fax:620-784-2583
Practice Address - Street 1:416 S. HUSTON
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:KS
Practice Address - Zip Code:67330-9267
Practice Address - Country:US
Practice Address - Phone:620-784-2580
Practice Address - Fax:620-784-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS118034OtherPROVIDER #
KS100395240AMedicaid
KS661770OtherPROVIDER #
KS4184060001Medicare NSC