MEDICARE: INDEPENDENCE REHAB 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	332BC3200X	Customized Equipment (DME)	0098372	TX
2	332B00000X	Durable Medical Equipment & Medical Supplies	0098372	TX

General Provider Information

NPI Number	:	1366624223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCE REHAB EQUIPMENT INC

Provider Business Mailing Address
First Line	:	8844 TRADEWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-6115
Country	:	US
Telephone Number	:	210-832-9770
Fax Number	:	210-832-0010

Provider Business Practice Location Address
First Line	:	8844 TRADEWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-6115
Country	:	US
Telephone Number	:	210-832-9770
Fax Number	:	210-832-0010

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEN C. HEALY
Credential	:
Telephone Number	:	210-832-9770

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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