MEDICARE: MEDISYN PRIME SOLUTION 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	:	1205795531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDISYN PRIME SOLUTION LLC

Provider Business Mailing Address
First Line	:	3220 TRAILING VINES BND
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-1250
Country	:	US
Telephone Number	:	858-247-3616
Fax Number	:	858-247-3616

Provider Business Practice Location Address
First Line	:	3220 TRAILING VINES BND
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-1250
Country	:	US
Telephone Number	:	858-247-3616
Fax Number	:	858-247-3616

Authorized Official
Title or Position	:	CEO
Name	:	MOHAMMAD ANAS
Credential	:
Telephone Number	:	945-342-8683

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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