MEDICARE: PAIGE I, 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	0089200	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	519281	OTHER	TX	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1417980921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIGE I, INC

Provider Business Mailing Address
First Line	:	PO BOX 785
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77704
Country	:	US
Telephone Number	:	409-832-0303
Fax Number	:	409-832-0802

Provider Business Practice Location Address
First Line	:	3150 MEDICAL CENTER DR STE 3
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77701-4651
Country	:	US
Telephone Number	:	409-832-0303
Fax Number	:	409-832-0802

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VIRGINIA COLEMAN
Credential	:
Telephone Number	:	409-832-0303

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	03/23/2010

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Directions to “PAIGE I, INC ” Practice Location

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