Organization
RIDGECREST MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WENDY JUNE RUSSELL (OWNER)
(760) 375-6200
Entity
Organization
Contact information
Practice address
137 PANAMINT AVE, RIDGECREST, CA 93555-3829
(760) 375-6200
(760) 375-3006
Mailing address
5213 LAKE ISABELLA BLVD, LAKE ISABELLA, CA 93240-9642
(760) 379-8111
(760) 379-1411
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME01825F
—
CA
Enumeration date
10/16/2005
Last updated
08/22/2020
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