MEDICARE: MEDBOXED 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	:	1114435021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDBOXED LLC

Provider Business Mailing Address
First Line	:	1906 SILVER ST
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-6645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 SILVER ST
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-6645
Country	:	US
Telephone Number	:	972-207-6000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY AARON WILLIAMS
Credential	:
Telephone Number	:	972-207-6000

Provider Enumeration Date	:	01/12/2018
Last Update Date	:	01/12/2018

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Directions to “MEDBOXED LLC ” Practice Location

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