MEDICARE: CDM SUPPLY, 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	332BN1400X	Nursing Facility Supplies (DME)

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	:	1437356508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDM SUPPLY, LLC

Provider Business Mailing Address
First Line	:	N50W13740 OVERVIEW DR
Second Line	:	SUITE B
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-7062
Country	:	US
Telephone Number	:	262-781-7690
Fax Number	:	262-781-7692

Provider Business Practice Location Address
First Line	:	N50W13740 OVERVIEW DR
Second Line	:	SUITE B
City	:	MENOMONEE FALLS
State	:	WI
Zip	:	53051-7062
Country	:	US
Telephone Number	:	262-781-7690
Fax Number	:	262-781-7692

Authorized Official
Title or Position	:	MANAGER
Name	:	DALE ALAN RUNGE
Credential	:
Telephone Number	:	262-781-7690

Provider Enumeration Date	:	07/01/2007
Last Update Date	:	12/18/2007

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