MEDICARE: MAHOGANY DME 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	:	1073062105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHOGANY DME LLC

Provider Business Mailing Address
First Line	:	17300 DALLAS PKWY
Second Line	:	SUITE 1080
City	:	DALLAS
State	:	TX
Zip	:	75248-1145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17300 DALLAS PKWY
Second Line	:	SUITE 1080
City	:	DALLAS
State	:	TX
Zip	:	75248-1145
Country	:	US
Telephone Number	:	815-482-2973
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEITH PALMER
Credential	:
Telephone Number	:	815-482-2973

Provider Enumeration Date	:	09/30/2016
Last Update Date	:	09/30/2016

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