Provider Demographics
NPI:1548365703
Name:HEALTHCARE SUPPLY NETWORK, INC.
Entity type:Organization
Organization Name:HEALTHCARE SUPPLY NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-829-7181
Mailing Address - Street 1:PO BOX 13034
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0051
Mailing Address - Country:US
Mailing Address - Phone:480-829-7181
Mailing Address - Fax:
Practice Address - Street 1:5030 S MILL AVE
Practice Address - Street 2:SUITE D-18
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-6833
Practice Address - Country:US
Practice Address - Phone:480-829-7181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0446960001Medicare NSC