Provider Demographics
NPI:1932144201
Name:ROURE MEDICAL SUPPLY
Entity type:Organization
Organization Name:ROURE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOEMI
Authorized Official - Middle Name:I
Authorized Official - Last Name:ROURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-280-1390
Mailing Address - Street 1:31 CALLE MENDEZ LICIAGA
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2422
Mailing Address - Country:US
Mailing Address - Phone:787-280-1390
Mailing Address - Fax:787-280-1390
Practice Address - Street 1:31 CALLE MENDEZ LICIAGA
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2422
Practice Address - Country:US
Practice Address - Phone:787-280-1390
Practice Address - Fax:787-280-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1199260001Medicare NSC