MEDICARE: MRS. JO EVELYN FLANAGAN

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	174400000X	Specialist
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1376541037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JO EVELYN FLANAGAN

Provider Business Mailing Address
First Line	:	355 E 21ST ST
Second Line	:	SUITE J
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4851
Country	:	US
Telephone Number	:	909-882-0193
Fax Number	:	909-883-4834

Provider Business Practice Location Address
First Line	:	355 E 21ST ST
Second Line	:	SUITE J
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4851
Country	:	US
Telephone Number	:	909-882-0193
Fax Number	:	909-883-4834

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/15/2021

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