Provider Demographics
NPI:1104869452
Name:RELIANCE MEDICAL, INC.
Entity type:Organization
Organization Name:RELIANCE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-692-7443
Mailing Address - Street 1:2500 S WILLIS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6255
Mailing Address - Country:US
Mailing Address - Phone:325-692-7443
Mailing Address - Fax:325-692-3566
Practice Address - Street 1:101 EAST ERMA
Practice Address - Street 2:
Practice Address - City:PRESIDIO
Practice Address - State:TX
Practice Address - Zip Code:79845
Practice Address - Country:US
Practice Address - Phone:432-229-3828
Practice Address - Fax:432-229-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0061503332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1051990002Medicare NSC