MEDICARE: MICHAEL R MULLINS II INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053444968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL R MULLINS II INC

Provider Business Mailing Address
First Line	:	301 GEORGE KOSTAS DR
Second Line	:
City	:	LOGAN
State	:	WV
Zip	:	25601-3493
Country	:	US
Telephone Number	:	304-752-1450
Fax Number	:	304-752-4390

Provider Business Practice Location Address
First Line	:	301 GEORGE KOSTAS DR
Second Line	:
City	:	LOGAN
State	:	WV
Zip	:	25601-3493
Country	:	US
Telephone Number	:	304-752-1450
Fax Number	:	304-752-4390

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL RAY MULLINS II
Credential	:
Telephone Number	:	304-752-1450

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	02/02/2015

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