MEDICARE: AMERICAN SOUTHWEST CPM & MEDICAL SUPPLY, 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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1184611329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN SOUTHWEST CPM & MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	8686 N CENTRAL AVE
Second Line	:	#112
City	:	PHOENIX
State	:	AZ
Zip	:	85020-3153
Country	:	US
Telephone Number	:	602-957-4700
Fax Number	:	602-264-9015

Provider Business Practice Location Address
First Line	:	8686 N CENTRAL AVE
Second Line	:	#112
City	:	PHOENIX
State	:	AZ
Zip	:	85020-3153
Country	:	US
Telephone Number	:	602-957-4700
Fax Number	:	602-264-9015

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MR. KEVIN ROYCE RANDALL
Credential	:
Telephone Number	:	602-957-4700

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	09/14/2016

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