MEDICARE: MEDICINE CHEST MEDICAL SUPPLY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BX2000X	Oxygen Equipment & Supplies (DME)
3	335E00000X	Prosthetic/Orthotic Supplier
4	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	185109901	OTHER	TX	TPI
2	185109902	OTHER	TX	TPI
3	1194822478	OTHER	TX	NPI

General Provider Information

NPI Number	:	1194822478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICINE CHEST MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	411 MAIN ST
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2762
Country	:	US
Telephone Number	:	903-885-0821
Fax Number	:	903-885-8734

Provider Business Practice Location Address
First Line	:	513 E GARLAND ST
Second Line	:
City	:	GRAND SALINE
State	:	TX
Zip	:	75140-1984
Country	:	US
Telephone Number	:	903-962-4251
Fax Number	:	903-885-8734

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DWAYNE MCCORMACK
Credential	:	RES THERAPIST
Telephone Number	:	903-962-4251

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/19/2008

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Directions to “MEDICINE CHEST MEDICAL SUPPLY, INC. ” Practice Location

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