MEDICARE: FAMILY MEDICAL SUPPLY, LLC

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	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	118064	OTHER	KS	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1356390363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	1542 E 61ST ST N
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-1953
Country	:	US
Telephone Number	:	316-744-1261
Fax Number	:	316-744-3443

Provider Business Practice Location Address
First Line	:	1542 E 61ST ST N
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-1953
Country	:	US
Telephone Number	:	316-744-1261
Fax Number	:	316-744-3443

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LISA RENE SMITH
Credential	:
Telephone Number	:	316-744-1261

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	08/22/2020

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Directions to “FAMILY MEDICAL SUPPLY, LLC ” Practice Location

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