MEDICARE: AGL MEDICAL SUPPLIES 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	:	1932373248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGL MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	810 S MASON RD
Second Line	:	SUITE 302
City	:	KATY
State	:	TX
Zip	:	77450-3895
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 S MASON RD
Second Line	:	SUITE 302
City	:	KATY
State	:	TX
Zip	:	77450-3895
Country	:	US
Telephone Number	:	281-702-8735
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IJE MOZIE
Credential	:
Telephone Number	:	281-702-8735

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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