MEDICARE: REMKE MEDICAL 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)	MG0479	KY
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	MG0479	KY
3	332B00000X	Durable Medical Equipment & Medical Supplies	MG0479	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000361585	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376542019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REMKE MEDICAL LLC

Provider Business Mailing Address
First Line	:	20 MEDICAL VILLAGE DR
Second Line	:	SUITE 103
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-5401
Country	:	US
Telephone Number	:	859-341-3456
Fax Number	:	859-341-3585

Provider Business Practice Location Address
First Line	:	20 MEDICAL VILLAGE DR
Second Line	:	SUITE 103
City	:	EDGEWOOD
State	:	KY
Zip	:	41017-5401
Country	:	US
Telephone Number	:	859-341-3456
Fax Number	:	859-341-3585

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM HENRY REMKE
Credential	:
Telephone Number	:	859-341-3456

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	01/19/2012

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Directions to “REMKE MEDICAL LLC ” Practice Location

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