MEDICARE: BACK TO BACK MEDICAL EQUIPMENT DIST LLC

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	0075614	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10048516	OTHER	TX	AMERIGROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	200436441	OTHER	TX	PHCS
4	HOMELINK	OTHER	TX	200436441
5	100265265301	OTHER	TX	UNITEDHEALTH CARE
6	8200381	OTHER	TX	EVERCARE
7	200436441	OTHER	TX	INTEGRATED HEALTH PLAN
8	531679	OTHER	TX	BLUECROSS/BLUESHIELD OF T
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	172929501	OTHER	TX	COMM HEALTH CHOICE

General Provider Information

NPI Number	:	1619047636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK TO BACK MEDICAL EQUIPMENT DIST LLC

Provider Business Mailing Address
First Line	:	817 SOUTHMORE AVE
Second Line	:	STE 100 I
City	:	PASADENA
State	:	TX
Zip	:	77502-1115
Country	:	US
Telephone Number	:	713-477-0780
Fax Number	:	855-873-8930

Provider Business Practice Location Address
First Line	:	817 SOUTHMORE AVE
Second Line	:	STE 100 I
City	:	PASADENA
State	:	TX
Zip	:	77502-1115
Country	:	US
Telephone Number	:	713-477-0780
Fax Number	:	855-873-8930

Authorized Official
Title or Position	:	OWNER CEO
Name	:	MS. ASHLEY WASHINGTON
Credential	:
Telephone Number	:	713-477-0780

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	03/28/2014

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