MEDICARE: DAISY INCONTINENCE AND MEDICAL SUPPLY, 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	:	1053648071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAISY INCONTINENCE AND MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	6081 MEEKS WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95835-1923
Country	:	US
Telephone Number	:	916-320-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 22ND AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-6425
Country	:	US
Telephone Number	:	916-320-0707
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MICHELLE L GITTINS
Credential	:
Telephone Number	:	916-320-0707

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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