MEDICARE: BURGOS HOSPITAL SUPPLY INC

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	332BX2000X	Oxygen Equipment & Supplies (DME)	05- P 1848	PR
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)		PR

General Provider Information

NPI Number	:	1235133125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BURGOS HOSPITAL SUPPLY INC

Provider Business Mailing Address
First Line	:	URB. SANTA MONICA A13 CALLE 13
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00957-1807
Country	:	US
Telephone Number	:	787-288-2702
Fax Number	:	787-288-2704

Provider Business Practice Location Address
First Line	:	A13 CALLE 13
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00957-1807
Country	:	US
Telephone Number	:	787-288-2702
Fax Number	:	787-288-2704

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ADALBERTO A. BURGOS
Credential	:
Telephone Number	:	787-288-2702

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/11/2008

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