# RIDGECREST MEDICAL SUPPLY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932198678
- **Authorized official:** MRS. WENDY JUNE RUSSELL (OWNER)
- **Authorized official phone:** (760) 375-6200

## Contact information

- **Practice address:** 137 PANAMINT AVE, RIDGECREST, CA 93555-3829
- **Practice address phone:** (760) 375-6200
- **Practice address fax:** (760) 375-3006
- **Mailing address:** 5213 LAKE ISABELLA BLVD, LAKE ISABELLA, CA 93240-9642
- **Mailing address phone:** (760) 379-8111
- **Mailing address fax:** (760) 379-1411

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 10/16/2005
- **Last updated:** 08/22/2020