MEDICARE: HARRY'S MOBILE DISTRIBUTOR OF MEDICAL EQUIP

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		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184691446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRY'S MOBILE DISTRIBUTOR OF MEDICAL EQUIP

Provider Business Mailing Address
First Line	:	4661 HAYGOOD RD
Second Line	:	SUITE 109
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5435
Country	:	US
Telephone Number	:	757-460-0883
Fax Number	:	757-460-0727

Provider Business Practice Location Address
First Line	:	4661 HAYGOOD RD
Second Line	:	109
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-5435
Country	:	US
Telephone Number	:	757-460-0883
Fax Number	:	757-460-0727

Authorized Official
Title or Position	:	OWNER / OPERATOR
Name	:	HARRY SANCHEZ
Credential	:
Telephone Number	:	757-470-2388

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	07/30/2008

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