MEDICARE: VOYAAGE PRACTICE MANAGEMENT

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	:	1144704966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOYAAGE PRACTICE MANAGEMENT

Provider Business Mailing Address
First Line	:	111 W TYLER ST
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75601-6318
Country	:	US
Telephone Number	:	903-212-3263
Fax Number	:	817-887-2377

Provider Business Practice Location Address
First Line	:	111 W TYLER ST
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75601-6318
Country	:	US
Telephone Number	:	903-212-3263
Fax Number	:	817-887-2377

Authorized Official
Title or Position	:	ACCOUNT MANAGER
Name	:	AMANDA SKY BUCHANAN
Credential	:
Telephone Number	:	903-212-3263

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/18/2018

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Directions to “VOYAAGE PRACTICE MANAGEMENT ” Practice Location

Language	Start Address	Practice Location

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