MEDICARE: A FITTING PLACE 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	6508247	MN

General Provider Information

NPI Number	:	1235137985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A FITTING PLACE LLC

Provider Business Mailing Address
First Line	:	209 SIBLEY ST
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-1226
Country	:	US
Telephone Number	:	651-480-3578
Fax Number	:	651-480-3584

Provider Business Practice Location Address
First Line	:	209 SIBLEY ST
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-1226
Country	:	US
Telephone Number	:	651-480-3578
Fax Number	:	651-480-3584

Authorized Official
Title or Position	:	OWNER
Name	:	DARCI ELIZABETH SMITH
Credential	:
Telephone Number	:	651-480-3578

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/14/2013

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