MEDICARE: MEDICAL FACILITIES OF AMERICA SUPPLY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BC3200X	Customized Equipment (DME)
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1316276520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL FACILITIES OF AMERICA SUPPLY SERVICES, LLC

Provider Business Mailing Address
First Line	:	2917 PENN FOREST BLVD
Second Line	:	SUITE 10
City	:	ROANOKE
State	:	VA
Zip	:	24018-4374
Country	:	US
Telephone Number	:	540-776-7497
Fax Number	:	540-339-9124

Provider Business Practice Location Address
First Line	:	2917 PENN FOREST BLVD
Second Line	:	SUITE 10
City	:	ROANOKE
State	:	VA
Zip	:	24018-4374
Country	:	US
Telephone Number	:	540-776-7497
Fax Number	:	540-339-9124

Authorized Official
Title or Position	:	CFO MFA INC., MANAGER
Name	:	NOVEL MARTIN
Credential	:
Telephone Number	:	540-776-7497

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	05/20/2014

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