MEDICARE: MABELINE 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	332B00000X	Durable Medical Equipment & Medical Supplies	1-57-016146	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18351	OTHER	IA	WELLMARK BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1245407998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MABELINE INC.

Provider Business Mailing Address
First Line	:	3136 MOUNT VERNON RD SE
Second Line	:	SUITE B
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-3655
Country	:	US
Telephone Number	:	319-363-3391
Fax Number	:	319-364-8610

Provider Business Practice Location Address
First Line	:	3136 MOUNT VERNON RD SE
Second Line	:	SUITE B
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-3655
Country	:	US
Telephone Number	:	319-363-3391
Fax Number	:	319-364-8610

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFFREY SCOTT ABRAHAM SR.
Credential	:
Telephone Number	:	319-363-3391

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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Directions to “MABELINE INC. ” Practice Location

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