MEDICARE: FOREST L CALHOUN JR

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

General Provider Information

NPI Number	:	1730378126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREST L CALHOUN JR

Provider Business Mailing Address
First Line	:	5709 WESTCREEK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3301
Country	:	US
Telephone Number	:	817-292-1622
Fax Number	:	817-423-2313

Provider Business Practice Location Address
First Line	:	5709 WESTCREEK DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-3301
Country	:	US
Telephone Number	:	817-292-1622
Fax Number	:	817-423-2313

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FOREST L CALHOUN JR.
Credential	:
Telephone Number	:	817-292-1622

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	07/23/2008

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Directions to “FOREST L CALHOUN JR ” Practice Location

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