Provider Demographics
NPI:1043316771
Name:R. A. MEDICAL COMPANY
Entity type:Organization
Organization Name:R. A. MEDICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NOBLE
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:WAIDELICH
Authorized Official - Suffix:SR
Authorized Official - Credentials:RRT
Authorized Official - Phone:707-463-0160
Mailing Address - Street 1:407 E PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4506
Mailing Address - Country:US
Mailing Address - Phone:707-463-0160
Mailing Address - Fax:707-463-0532
Practice Address - Street 1:407 E PERKINS ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4506
Practice Address - Country:US
Practice Address - Phone:707-463-0160
Practice Address - Fax:707-463-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 335E00000X
CA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ97844ZOtherBLUE SHIELD
CADME00294HMedicaid
ZZZ97844ZOtherBLUE SHIELD