MEDICARE: MASVIDA HEALTH CARE SOLUTIONS, LLC

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	:	1912760646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASVIDA HEALTH CARE SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	133 NURSERY LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-4334
Country	:	US
Telephone Number	:	817-704-3103
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602A MACKS DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5326
Country	:	US
Telephone Number	:	817-704-3103
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	BRANDI WHITELEY
Credential	:
Telephone Number	:	817-704-3103

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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