MEDICARE: REGENCY MEDICAL BRACING AND SUPPLY

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	213E00000X	Podiatrist	SC005640	PA

General Provider Information

NPI Number	:	1699185405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENCY MEDICAL BRACING AND SUPPLY

Provider Business Mailing Address
First Line	:	160 PITTSBURGH ST
Second Line	:	SUITE 3B
City	:	UNIONTOWN
State	:	PA
Zip	:	15401-2300
Country	:	US
Telephone Number	:	724-439-3338
Fax Number	:	724-439-3337

Provider Business Practice Location Address
First Line	:	160 PITTSBURGH ST
Second Line	:	SUITE 3B
City	:	UNIONTOWN
State	:	PA
Zip	:	15401-2300
Country	:	US
Telephone Number	:	724-439-3338
Fax Number	:	724-439-3337

Authorized Official
Title or Position	:	D.P.M.
Name	:	DR. WILLIAM AINSLEY
Credential	:	D.P.M.
Telephone Number	:	724-439-3338

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2014

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