MEDICARE: MISSION HEALTH CONCEPTS, 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

General Provider Information

NPI Number	:	1790126431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION HEALTH CONCEPTS, INC

Provider Business Mailing Address
First Line	:	215 MUSHROOM BLVD BLDG 18
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-3256
Country	:	US
Telephone Number	:	585-427-0380
Fax Number	:	585-427-2604

Provider Business Practice Location Address
First Line	:	215 MUSHROOM BLVD BLDG 18
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-3256
Country	:	US
Telephone Number	:	585-427-0380
Fax Number	:	585-427-2604

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JONATHAN D WALTERS
Credential	:
Telephone Number	:	585-427-0380

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	07/10/2013

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