MEDICARE: BACONSFIELD HOMECARE EQUIPMENT 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	335E00000X	Prosthetic/Orthotic Supplier
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326041732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACONSFIELD HOMECARE EQUIPMENT INC

Provider Business Mailing Address
First Line	:	1042 GRAY HWY
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31211-1837
Country	:	US
Telephone Number	:	478-743-4557
Fax Number	:	478-742-4522

Provider Business Practice Location Address
First Line	:	1042 GRAY HWY
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31211-1837
Country	:	US
Telephone Number	:	478-743-4557
Fax Number	:	478-742-4522

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MISS WENDY M WILLIAMS
Credential	:
Telephone Number	:	478-743-4557

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/13/2012

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