Active NPI
Reliant Medical LLC
Doing business as Reliant Healthcare
- Community/Retail Pharmacy
- Vicksburg, MS
National Provider Identifier
1972925303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 12953/ 2.6
- Legal business name
- RELIANT MEDICAL LLC
- Doing business as
- Reliant Healthcare
- Practice address
- 3532 Manor Dr Ste 4
Vicksburg, MS 39180-5629 - Phone
- (877) 354-2688
- Fax
- (318) 322-0998
- NPI assigned
- Jan 21, 2014
- Last updated
- Jul 8, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brad Smith
- Title
- Ceo
- Phone
- (318) 322-8326
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 12953/ 2.6 | MS | Primary |
Addresses
Primary practice location
3532 Manor Dr Ste 4
Vicksburg, MS 39180-5629
Mailing address
PO Box 2293
Monroe, LA 71207-2293
Phone (877) 354-2688
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2143959 | Other | PK |
Other names 1
- Reliant Healthcare
National Provider Directory
National Provider Directory- Tax ID family
- Reliant Medical LLC
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
Locations
3532 Manor Dr
Ste 4
Vicksburg, MS 39180
Phone (877) 354-2688
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1390262400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1467936000000",
"number": "1972925303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2293",
"city": "MONROE",
"state": "LA",
"postal_code": "712072293",
"telephone_number": "877-354-2688",
"fax_number": "318-354-0998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3532 MANOR DR STE 4",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391805629",
"telephone_number": "877-354-2688",
"fax_number": "318-322-0998"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RELIANT MEDICAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-01-21",
"last_updated": "2016-07-08",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "BRAD",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "318-322-8326"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MS",
"license": "12953/ 2.6",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2143959",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Reliant Healthcare",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Vicksburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.