MEDICARE: URGENT MEDICAL SUPPLIES 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

General Provider Information

NPI Number	:	1386925626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URGENT MEDICAL SUPPLIES INC.

Provider Business Mailing Address
First Line	:	4015 E BELL RD
Second Line	:	SUITE 130
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2243
Country	:	US
Telephone Number	:	602-345-7181
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 E BELL RD
Second Line	:	SUITE 130
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2243
Country	:	US
Telephone Number	:	602-354-7181
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. NICKOLAS S JOHANNSEN
Credential	:
Telephone Number	:	602-354-7181

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	05/29/2012

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