Provider Demographics
NPI:1871801902
Name:MAULIN MEDICAL LLC
Entity type:Organization
Organization Name:MAULIN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MAULIN
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:719-647-2938
Mailing Address - Street 1:486 E. GENTRY DR.
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST,
Mailing Address - State:CO
Mailing Address - Zip Code:81007
Mailing Address - Country:US
Mailing Address - Phone:719-647-2938
Mailing Address - Fax:
Practice Address - Street 1:486 E GENTRY DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-3424
Practice Address - Country:US
Practice Address - Phone:719-647-2938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition