MEDICARE: EVIS MEDICAL EQUIPMENT 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	332BX2000X	Oxygen Equipment & Supplies (DME)	CSW0001665	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437133956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVIS MEDICAL EQUIPMENT INC

Provider Business Mailing Address
First Line	:	751 MAPLE AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06114-2315
Country	:	US
Telephone Number	:	860-296-3565
Fax Number	:

Provider Business Practice Location Address
First Line	:	751 MAPLE AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06114-2315
Country	:	US
Telephone Number	:	860-296-3565
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MRS. GISELLA P MONCAYO
Credential	:
Telephone Number	:	860-296-3565

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	08/29/2012

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