MEDICARE: MEDHAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BN1400X	Nursing Facility Supplies (DME)
3	335E00000X	Prosthetic/Orthotic Supplier
4	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1033490578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDHAB

Provider Business Mailing Address
First Line	:	1120 SOUTH FWY
Second Line	:	SUITE 105
City	:	FORT WORTH
State	:	TX
Zip	:	76104-5064
Country	:	US
Telephone Number	:	817-233-5271
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3812
Country	:	US
Telephone Number	:	817-233-5271
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. JOHNNY ROSS JR.
Credential	:
Telephone Number	:	817-233-5271

Provider Enumeration Date	:	08/29/2011
Last Update Date	:	02/07/2013

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Directions to “MEDHAB ” Practice Location

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