MEDICARE: ANDDAV ANALYSIS, 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	332B00000X	Durable Medical Equipment & Medical Supplies		MS

General Provider Information

NPI Number	:	1154508935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDDAV ANALYSIS, INC.

Provider Business Mailing Address
First Line	:	9370 WILSON MILL RD
Second Line	:
City	:	LAKE CORMORANT
State	:	MS
Zip	:	38641-9480
Country	:	US
Telephone Number	:	901-652-0066
Fax Number	:	662-781-2704

Provider Business Practice Location Address
First Line	:	9370 WILSON MILL RD
Second Line	:
City	:	LAKE CORMORANT
State	:	MS
Zip	:	38641-9480
Country	:	US
Telephone Number	:	901-652-0066
Fax Number	:	662-781-2704

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JAY CLARK
Credential	:
Telephone Number	:	901-652-0066

Provider Enumeration Date	:	01/24/2008
Last Update Date	:	01/24/2008

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