MEDICARE: M&C SIGNATURE, 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	:	1063843977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M&C SIGNATURE, LLC

Provider Business Mailing Address
First Line	:	1474 W GRANADA BLVD
Second Line	:	SUITE 475
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-9187
Country	:	US
Telephone Number	:	386-677-7011
Fax Number	:	386-677-7075

Provider Business Practice Location Address
First Line	:	1474 W GRANADA BLVD
Second Line	:	SUITE 475
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-9187
Country	:	US
Telephone Number	:	386-677-7011
Fax Number	:	386-677-7075

Authorized Official
Title or Position	:	MANAGER
Name	:	OLGA D HIGGINS
Credential	:
Telephone Number	:	407-721-5217

Provider Enumeration Date	:	12/02/2013
Last Update Date	:	12/02/2013

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Directions to “M&C SIGNATURE, LLC ” Practice Location

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