Provider Demographics
NPI:1912911298
Name:REYLAND MEDICAL, LLC
Entity type:Organization
Organization Name:REYLAND MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-244-0240
Mailing Address - Street 1:3605 SANDY PLAINS RD STE 240 #234
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3066
Mailing Address - Country:US
Mailing Address - Phone:844-244-0240
Mailing Address - Fax:866-277-9277
Practice Address - Street 1:1053 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-6861
Practice Address - Country:US
Practice Address - Phone:844-244-0240
Practice Address - Fax:866-277-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC032385455332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE2732Medicaid
GA003149785AMedicaid
SCDE2732Medicaid