MEDICARE: FISHING CAR INC.

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	332BC3200X	Customized Equipment (DME)	32025591903	TX

General Provider Information

NPI Number	:	1073765491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISHING CAR INC.

Provider Business Mailing Address
First Line	:	163 PARKWAY DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-2610
Country	:	US
Telephone Number	:	817-932-2697
Fax Number	:

Provider Business Practice Location Address
First Line	:	5111 WHITE SETTLEMENT RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-3901
Country	:	US
Telephone Number	:	817-377-9979
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MIGUEL TORRES
Credential	:
Telephone Number	:	817-932-2697

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	10/16/2008

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