MEDICARE: HEALTH COMPLEX MEDICAL, 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)

General Provider Information

NPI Number	:	1275799306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH COMPLEX MEDICAL, INC.

Provider Business Mailing Address
First Line	:	84 PROGRESS LN
Second Line	:
City	:	WATERBURY
State	:	CT
Zip	:	06705-3863
Country	:	US
Telephone Number	:	203-753-7778
Fax Number	:	203-753-7779

Provider Business Practice Location Address
First Line	:	54 MAIN ST
Second Line	:	STE E
City	:	DANBURY
State	:	CT
Zip	:	06810-3009
Country	:	US
Telephone Number	:	203-205-0457
Fax Number	:	203-207-4688

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JOHN E HOGAN II
Credential	:
Telephone Number	:	203-346-7526

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	01/20/2012

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