MEDICARE: SUPPLY RESOURCES 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

General Provider Information

NPI Number	:	1326374646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPPLY RESOURCES INC

Provider Business Mailing Address
First Line	:	9162 ESTATE THOMAS
Second Line	:	BAY 4 AND 5
City	:	ST THOMAS
State	:	VI
Zip	:	00802-2602
Country	:	US
Telephone Number	:	340-775-7483
Fax Number	:	340-776-3878

Provider Business Practice Location Address
First Line	:	9162 ESTATE THOMAS
Second Line	:	BAY 4 AND 5
City	:	ST THOMAS
State	:	VI
Zip	:	00802-2602
Country	:	US
Telephone Number	:	340-775-7483
Fax Number	:	340-776-3878

Authorized Official
Title or Position	:	SALES MANAGER
Name	:	LYNN DELANEY
Credential	:
Telephone Number	:	340-775-7483

Provider Enumeration Date	:	10/21/2009
Last Update Date	:	10/21/2009

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