MEDICARE: SIMONE LETANG-FREEMAN

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	332BC3200X	Customized Equipment (DME)	1-13417-1L	VI

General Provider Information

NPI Number	:	1548685076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMONE LETANG-FREEMAN

Provider Business Mailing Address
First Line	:	4001 RAPHUNE HILL RD STE 106
Second Line	:	ELITE MEDICAL SUPPLY
City	:	ST THOMAS
State	:	VI
Zip	:	00802-2905
Country	:	US
Telephone Number	:	340-779-8116
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 RAPHUNE HILL RD STE 106
Second Line	:	ELITE MEDICAL SUPPLY
City	:	ST THOMAS
State	:	VI
Zip	:	00802-2905
Country	:	US
Telephone Number	:	340-779-8116
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2014
Last Update Date	:	02/20/2014

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