MEDICARE: A2 MEDICAL SUPPLY

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	603430737	WA

General Provider Information

NPI Number	:	1215338702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A2 MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	3241 34TH AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-2614
Country	:	US
Telephone Number	:	206-557-9415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3241 34TH AVE W
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-2614
Country	:	US
Telephone Number	:	206-557-9415
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN ANGELO ESPIRITU JIMENEZ
Credential	:
Telephone Number	:	206-557-9415

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	09/15/2014

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