MEDICARE: LINCLON MEDICAL SUPPLY

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	TXDME	TX

General Provider Information

NPI Number	:	1386839116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCLON MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	PO BOX 10347
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78460-0347
Country	:	US
Telephone Number	:	713-576-6903
Fax Number	:

Provider Business Practice Location Address
First Line	:	4009 BELLAIRE BLVD
Second Line	:	#K
City	:	HOUSTON
State	:	TX
Zip	:	77025-1168
Country	:	US
Telephone Number	:	713-576-6903
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARK EDWARD FARIAS
Credential	:	B.S.
Telephone Number	:	713-576-6903

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	09/14/2007

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Directions to “LINCLON MEDICAL SUPPLY ” Practice Location

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