Organization
RENAISSANCE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES C GRAHAM RRT (PRESIDENT)
(606) 878-0453
Entity
Organization
Contact information
Practice address
4530 BISHOP LN, SUITE 100, LOUISVILLE, KY 40218-4561
(502) 961-8560
(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
HME00021
KY
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
MG0190
KY
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000070422
ANTHEM
—
01
—
006895400
US DEPT OF LABOR
—
01
—
040021100
FEDERAL BLACK LUNG PROGRA
—
01
—
1079739
PASSPORT
KY
01
—
110110
AMERICAN BENEFIT PLAN
—
01
—
1171574
CUMBERLAND HEALTHCARE
—
01
—
119010
BCBS MI ABP PLAN
—
01
—
164438
IN STATE DEPT HLTH CSH
—
01
—
2196098
AETNA
—
01
—
228579
GHP
—
01
—
26404V2111
AHDS
—
05
—
7100165610
—
KY
05
—
7100166520
—
KY
01
—
822271
BCBS PENN
—
01
—
C82003
CHI
—
01
—
C82008
CHI
—
01
—
S864
ANTHEM
—
Enumeration date
08/11/2005
Last updated
06/02/2020
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