=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255671152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAC'S MEDICAL EQUIPMENT AND SUPPLIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2013
-----------------------------------------------------
Last Update Date | 03/01/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26102 LEE HIGHWAY
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-525-4622
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26102 LEE HIGHWAY
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-525-4522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | PAULA L MULLINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 276-623-4260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------