Organization
GREEN RIVER MEDICAL EQUIPMENT INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ED BAISE RPH (OWNER)
(270) 465-2400
Entity
Organization
Contact information
Practice address
327 E BROADWAY ST, CAMPBELLSVILLE, KY 42718-2003
(270) 465-2400
Mailing address
327 E BROADWAY ST, CAMPBELLSVILLE, KY 42718-2003
(270) 465-2400
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000070226
DME
KY
05
—
90001041
—
KY
Enumeration date
07/11/2005
Last updated
06/06/2011
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