MEDICARE: MRS. ANGELA ROBBINS GEBERT

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	:	1356583918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA ROBBINS GEBERT

Provider Business Mailing Address
First Line	:	3428 BRISTERS SPRING RUN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6208
Country	:	US
Telephone Number	:	260-416-4623
Fax Number	:	260-748-7877

Provider Business Practice Location Address
First Line	:	5436 OLD MAUMEE RD
Second Line	:	UNIT 1
City	:	FORT WAYNE
State	:	IN
Zip	:	46803-1713
Country	:	US
Telephone Number	:	260-748-7711
Fax Number	:	260-748-7877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2009
Last Update Date	:	03/28/2009

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