Provider Demographics
NPI:1861426801
Name:RITECARE MEDICAL SUPPLY INCORPORATED
Entity type:Organization
Organization Name:RITECARE MEDICAL SUPPLY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:ETIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-396-0871
Mailing Address - Street 1:717 S GREENVILLE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3318
Mailing Address - Country:US
Mailing Address - Phone:972-396-0871
Mailing Address - Fax:972-396-2032
Practice Address - Street 1:717 S GREENVILLE AVE STE 102
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3318
Practice Address - Country:US
Practice Address - Phone:972-396-0871
Practice Address - Fax:972-396-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0056215332BX2000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5327770001Medicare NSC