MEDICARE: FACE DOWN RECOVERY EQUIPMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1013399807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FACE DOWN RECOVERY EQUIPMENT

Provider Business Mailing Address
First Line	:	3834 N 80TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-2922
Country	:	US
Telephone Number	:	414-409-7165
Fax Number	:

Provider Business Practice Location Address
First Line	:	3834 N 80TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-2922
Country	:	US
Telephone Number	:	414-409-7165
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JENNIFER ANN MCCARTHY
Credential	:
Telephone Number	:	414-409-7165

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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