MEDICARE: WORMILL 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	332BC3200X	Customized Equipment (DME)	87102	VA

General Provider Information

NPI Number	:	1437314754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WORMILL INC.

Provider Business Mailing Address
First Line	:	PO BOX 4055
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23664-0055
Country	:	US
Telephone Number	:	757-851-8000
Fax Number	:	757-850-3653

Provider Business Practice Location Address
First Line	:	2002 E PEMBROKE AVE
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23664-1111
Country	:	US
Telephone Number	:	757-851-8000
Fax Number	:	757-850-3653

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DOUGLAS WORNOM
Credential	:
Telephone Number	:	757-851-8000

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	07/25/2008

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