MEDICARE: M D M HOME MEDICAL EQUIPMENT, 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	:	1215177068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M D M HOME MEDICAL EQUIPMENT, LLC

Provider Business Mailing Address
First Line	:	PO BOX 4847
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-0847
Country	:	US
Telephone Number	:	940-691-0551
Fax Number	:	940-691-0757

Provider Business Practice Location Address
First Line	:	4084 REGENT DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-1508
Country	:	US
Telephone Number	:	940-691-0551
Fax Number	:	940-691-0757

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MR. LARRY DEWAYNE ANDRUS
Credential	:
Telephone Number	:	940-691-0551

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/05/2009

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