MEDICARE: PLUMTREE LLC

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	332BC3200X	Customized Equipment (DME)	2705117115	VA

General Provider Information

NPI Number	:	1043463060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLUMTREE LLC

Provider Business Mailing Address
First Line	:	50 PLUM TREE LN
Second Line	:
City	:	FORT VALLEY
State	:	VA
Zip	:	22652-3219
Country	:	US
Telephone Number	:	540-933-6006
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 PLUM TREE LN
Second Line	:
City	:	FORT VALLEY
State	:	VA
Zip	:	22652-3219
Country	:	US
Telephone Number	:	540-933-6006
Fax Number	:

Authorized Official
Title or Position	:	MEMBER MANAGER
Name	:	MR. SCOTT W KNAPP
Credential	:
Telephone Number	:	540-933-6006

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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