=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144207432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMBRY WELDING SUPPLY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2005
-----------------------------------------------------
Last Update Date | 08/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 INDUSTRIAL DR
-----------------------------------------------------
City | CANEYVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42721-9176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-879-9287
-----------------------------------------------------
Fax | 270-879-3405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 INDUSTRIAL DR
-----------------------------------------------------
City | CANEYVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42721-9176
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-879-9287
-----------------------------------------------------
Fax | 270-879-3405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MRS. ALMA L. EMBRY
-----------------------------------------------------
Credential | CRT
-----------------------------------------------------
Telephone | 270-879-9287
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 074211
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------