MEDICARE: WESTERN RESERVE MEDICAL SUPPLY 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
2	332BX2000X	Oxygen Equipment & Supplies (DME)

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

General Provider Information

NPI Number	:	1528069846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN RESERVE MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	5230 HAUSERMAN RD
Second Line	:	SUITE B
City	:	PARMA
State	:	OH
Zip	:	44130-1224
Country	:	US
Telephone Number	:	216-292-4406
Fax Number	:	216-252-4930

Provider Business Practice Location Address
First Line	:	5230 HAUSERMAN RD
Second Line	:	SUITE B
City	:	PARMA
State	:	OH
Zip	:	44130-1224
Country	:	US
Telephone Number	:	216-292-4406
Fax Number	:	216-252-4930

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	CAROL A. GILLIGAN
Credential	:
Telephone Number	:	216-252-3900

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2011

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