=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699890046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | B & W MEDICAL SUPPLIES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 04/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7951 COLLIN MCKINNEY PKWY SUITE 400
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-7823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-383-9622
-----------------------------------------------------
Fax | 214-383-9655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7951 COLLIN MCKINNEY PKWY SUITE 400
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-7823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-383-9622
-----------------------------------------------------
Fax | 214-383-9655
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | BRIAN D FERAGOTTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-383-9622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------