MEDICARE: FAMILY CARE MEDICAL EQUIPMENT 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	203000076	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104204	OTHER	IL	UNICARE
2	6070850	OTHER	IL	BCBS OF ILLINOIS
3	105343	OTHER	MO	BCBS OF MISSOURI

General Provider Information

NPI Number	:	1316939812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE MEDICAL EQUIPMENT INC.

Provider Business Mailing Address
First Line	:	1108 BROADWAY
Second Line	:
City	:	HIGHLAND
State	:	IL
Zip	:	62249-1917
Country	:	US
Telephone Number	:	618-654-1375
Fax Number	:	618-654-5302

Provider Business Practice Location Address
First Line	:	1108 BROADWAY
Second Line	:
City	:	HIGHLAND
State	:	IL
Zip	:	62249-1916
Country	:	US
Telephone Number	:	618-654-1375
Fax Number	:	618-654-5302

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES R RANKIN SR.
Credential	:	ATP
Telephone Number	:	618-654-1375

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/02/2016

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