MEDICARE: MD MEDICAL SUPPLIES AND UNIFORMS

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	332BX2000X	Oxygen Equipment & Supplies (DME)	1334	CA

General Provider Information

NPI Number	:	1386914802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD MEDICAL SUPPLIES AND UNIFORMS

Provider Business Mailing Address
First Line	:	321 SAN FELIPE RD.
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-5247
Country	:	US
Telephone Number	:	831-630-9002
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 SAN FELIPE RD STE 9
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-3035
Country	:	US
Telephone Number	:	831-801-4172
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA A DE AVILA
Credential	:
Telephone Number	:	831-630-9002

Provider Enumeration Date	:	01/02/2012
Last Update Date	:	10/11/2013

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