MEDICARE: ENTERPRISE 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

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
2	00000070323	OTHER	KY	BLUE CROSS

General Provider Information

NPI Number	:	1629186499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTERPRISE MEDICAL, INC

Provider Business Mailing Address
First Line	:	PO BOX 9150
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42002-9150
Country	:	US
Telephone Number	:	270-744-9600
Fax Number	:	270-744-0834

Provider Business Practice Location Address
First Line	:	1115 NORTH H. C. MATHIS DRIVE
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42001-2340
Country	:	US
Telephone Number	:	270-443-9494
Fax Number	:	270-442-7812

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. WILLIAM A. WOODS
Credential	:
Telephone Number	:	270-217-5199

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	10/29/2010

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Directions to “ENTERPRISE MEDICAL, INC ” Practice Location

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