MEDICARE: FRONTLINE MEDICAL INNOVATIONS 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

General Provider Information

NPI Number	:	1316236136
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRONTLINE MEDICAL INNOVATIONS LLC

Provider Business Mailing Address
First Line	:	4284 TRAIL BOSS DR
Second Line	:	SUITE 110
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7521
Country	:	US
Telephone Number	:	303-660-1238
Fax Number	:	303-872-6528

Provider Business Practice Location Address
First Line	:	4284 TRAIL BOSS DR
Second Line	:	SUITE 110
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7521
Country	:	US
Telephone Number	:	303-660-1238
Fax Number	:	303-872-6528

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. EDWIN T MCKENNA
Credential	:
Telephone Number	:	720-771-7137

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	03/16/2012

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