MEDICARE: MICKS ENTERPRISES

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	103280	CA

General Provider Information

NPI Number	:	1508837444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICKS ENTERPRISES

Provider Business Mailing Address
First Line	:	13122 SHERMAN WAY
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-4645
Country	:	US
Telephone Number	:	818-759-1368
Fax Number	:	818-759-1369

Provider Business Practice Location Address
First Line	:	13122 SHERMAN WAY
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-4645
Country	:	US
Telephone Number	:	818-759-1368
Fax Number	:	818-759-1369

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MIKE N NKWOCHA
Credential	:
Telephone Number	:	818-759-1368

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/28/2008

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