MEDICARE: TENDERCARE PEDI 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

General Provider Information

NPI Number	:	1740518620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDERCARE PEDI SUPPLY

Provider Business Mailing Address
First Line	:	610 GREENHILL DR
Second Line	:	#11203
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 GREENHILL DR
Second Line	:	#11203
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-2200
Country	:	US
Telephone Number	:	903-669-9632
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMIE BURGER
Credential	:
Telephone Number	:	903-669-9632

Provider Enumeration Date	:	12/03/2009
Last Update Date	:	12/03/2009

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Directions to “TENDERCARE PEDI SUPPLY ” Practice Location

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