MEDICARE: BRAD JOSEPH MATTE

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	:	1225176167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD JOSEPH MATTE

Provider Business Mailing Address
First Line	:	800 DAVID DR
Second Line	:	#116
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1396
Country	:	US
Telephone Number	:	985-397-0461
Fax Number	:	985-385-1415

Provider Business Practice Location Address
First Line	:	800 DAVID DR
Second Line	:	#116
City	:	MORGAN CITY
State	:	LA
Zip	:	70380-1396
Country	:	US
Telephone Number	:	985-397-0461
Fax Number	:	985-385-1415

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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