MEDICARE: HEALTH MART OF ABBEVILLE INC.

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	332BX2000X	Oxygen Equipment & Supplies (DME)	2725232-002	LA

General Provider Information

NPI Number	:	1063698157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH MART OF ABBEVILLE INC.

Provider Business Mailing Address
First Line	:	1100 VETERANS MEMORIAL DR
Second Line	:
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-3128
Country	:	US
Telephone Number	:	337-893-5335
Fax Number	:	337-893-5334

Provider Business Practice Location Address
First Line	:	1100 VETERANS MEMORIAL DR
Second Line	:
City	:	ABBEVILLE
State	:	LA
Zip	:	70510-3128
Country	:	US
Telephone Number	:	337-893-5335
Fax Number	:	337-893-5334

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WESLEY JAMES DAVID
Credential	:	RPH
Telephone Number	:	337-523-1851

Provider Enumeration Date	:	01/18/2008
Last Update Date	:	01/18/2008

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