Organization
REBUILDER MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J EVANS (BILLING MANAGER)
(877) 436-3894
Entity
Organization
Contact information
Practice address
636 TREELINE DR, CHARLES TOWN, WV 25414-4700
(304) 725-2202
(304) 725-4915
Mailing address
636 TREELINE DR, CHARLES TOWN, WV 25414-4700
(304) 725-2202
(304) 725-4915
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
200295036001
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001612860
BLUE CROSS
WV
Enumeration date
08/11/2008
Last updated
12/28/2009
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