MEDICARE: A & B MEDICAL SUPPLIES, LLC

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	2009031587	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2637253	OTHER	NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1427126242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A & B MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	444 GRACIE LN
Second Line	:
City	:	MOSCOW MILLS
State	:	MO
Zip	:	63362-1142
Country	:	US
Telephone Number	:	636-356-4803
Fax Number	:	636-356-4605

Provider Business Practice Location Address
First Line	:	444 GRACIE LN
Second Line	:
City	:	MOSCOW MILLS
State	:	MO
Zip	:	63362-1142
Country	:	US
Telephone Number	:	636-356-4803
Fax Number	:	636-356-4605

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	ANGELA HENDERSON
Credential	:
Telephone Number	:	636-356-4803

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	01/04/2011

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