MEDICARE: ALLCARE MEDICAL SUPPLY 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	:	1033472477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLCARE MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	381 EDGEWOOD TERRACE DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-6217
Country	:	US
Telephone Number	:	769-251-0931
Fax Number	:	769-257-6764

Provider Business Practice Location Address
First Line	:	381 EDGEWOOD TERRACE DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-6217
Country	:	US
Telephone Number	:	769-251-0931
Fax Number	:	769-257-6764

Authorized Official
Title or Position	:	CEO
Name	:	MISS PATRICIA HANKINS
Credential	:
Telephone Number	:	601-720-8270

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	06/20/2012

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