MEDICARE: 180 MEDICAL, 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	0000001066	TN

General Provider Information

NPI Number	:	1538452628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	180 MEDICAL, INC.

Provider Business Mailing Address
First Line	:	8516 NW EXPRESSWAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6010
Country	:	US
Telephone Number	:	877-688-2729
Fax Number	:	888-718-0633

Provider Business Practice Location Address
First Line	:	5175 ELMORE RD
Second Line	:	SUITE 18
City	:	MEMPHIS
State	:	TN
Zip	:	38134-5629
Country	:	US
Telephone Number	:	901-729-6742
Fax Number	:	888-718-0633

Authorized Official
Title or Position	:	CFO
Name	:	MR. JEFFERY B HENDRIX
Credential	:
Telephone Number	:	405-443-2985

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	05/18/2022

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