Provider Demographics
NPI:1326013749
Name:RYDALE MEDICAL, INC.
Entity type:Organization
Organization Name:RYDALE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOODLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-697-3949
Mailing Address - Street 1:16909 LAKESIDE HILLS PLZ
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4654
Mailing Address - Country:US
Mailing Address - Phone:402-697-3949
Mailing Address - Fax:402-697-3950
Practice Address - Street 1:16909 LAKESIDE HILLS PLZ
Practice Address - Street 2:SUITE 108
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4654
Practice Address - Country:US
Practice Address - Phone:402-697-3949
Practice Address - Fax:402-697-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENONE REQUIRED332B00000X, 332BC3200X, 332BD1200X, 332BN1400X, 332BP3500X, 332BX2000X, 332S00000X, 332U00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332S00000XSuppliersHearing Aid Equipment
No332U00000XSuppliersHome Delivered Meals
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025338400Medicaid
NED09862OtherBCBS NE
NE5569740001Medicare ID - Type UnspecifiedSUPPLIER # ALL REGIONS