MEDICARE: MARY & DAVID MEDICAL EQUIPMENT SERVICE & REPAIRS

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)	6001411	CA

General Provider Information

NPI Number	:	1366787921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY & DAVID MEDICAL EQUIPMENT SERVICE & REPAIRS

Provider Business Mailing Address
First Line	:	PO BOX 1563
Second Line	:
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93421-1563
Country	:	US
Telephone Number	:	805-481-1302
Fax Number	:	805-481-1060

Provider Business Practice Location Address
First Line	:	2567 FOWLER LN
Second Line	:	SUITE 2565
City	:	ARROYO GRANDE
State	:	CA
Zip	:	93420-9642
Country	:	US
Telephone Number	:	805-481-1302
Fax Number	:	805-481-1060

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MARY E. APODACA
Credential	:
Telephone Number	:	805-481-1302

Provider Enumeration Date	:	12/06/2012
Last Update Date	:	12/06/2012

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