Organization
RENAISSANCE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES C GRAHAM (PRESIDENT)
(606) 878-7522
Entity
Organization
Contact information
Practice address
1380 W 5TH ST, LONDON, KY 40741-1615
(606) 878-0453
(606) 878-1862
Mailing address
1380 W 5TH ST, LONDON, KY 40741-1615
(606) 878-0453
(606) 878-1862
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100205920
—
KY
Enumeration date
04/25/2007
Last updated
06/02/2020
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