MEDICARE: MAINTAINING CANCER THROUGH ELEGENCE CORP

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	:	1265687388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAINTAINING CANCER THROUGH ELEGENCE CORP

Provider Business Mailing Address
First Line	:	2441 E STATE ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-2216
Country	:	US
Telephone Number	:	765-474-1795
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 E STATE ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-2216
Country	:	US
Telephone Number	:	765-474-1795
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA MARIE BECKER
Credential	:
Telephone Number	:	765-474-1795

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	06/12/2009

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