MEDICARE: MSB, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295766244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MSB, INC.

Provider Business Mailing Address
First Line	:	707 NORTH FWY
Second Line	:	SUITE 114
City	:	FT WORTH
State	:	TX
Zip	:	76102-1702
Country	:	US
Telephone Number	:	817-335-5810
Fax Number	:	817-335-5920

Provider Business Practice Location Address
First Line	:	707 NORTH FWY
Second Line	:	SUITE 114
City	:	FT WORTH
State	:	TX
Zip	:	76102-1702
Country	:	US
Telephone Number	:	817-335-5810
Fax Number	:	817-335-5920

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MRS. SHERRY GODFREY
Credential	:	R.N.
Telephone Number	:	817-335-5810

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	11/23/2010

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Directions to “MSB, INC. ” Practice Location

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