MEDICARE: MEDICORE360, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1053610758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICORE360, LLC

Provider Business Mailing Address
First Line	:	101 LONG POINT COVE
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628
Country	:	US
Telephone Number	:	512-522-7111
Fax Number	:	512-535-3625

Provider Business Practice Location Address
First Line	:	115 N CENTRAL AVE
Second Line	:	SUITE C
City	:	CAMERON
State	:	TX
Zip	:	76520-3330
Country	:	US
Telephone Number	:	512-522-7111
Fax Number	:	512-535-3625

Authorized Official
Title or Position	:	PRES/CEO
Name	:	MR. HERMAN CARDENAS
Credential	:
Telephone Number	:	512-522-7111

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/21/2011

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