MEDICARE: LGM DISTRIBUTION CORP.

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		AZ

General Provider Information

NPI Number	:	1447761887
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LGM DISTRIBUTION CORP.

Provider Business Mailing Address
First Line	:	711 W ROSE LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1432
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 E THOMAS RD STE 12
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-7937
Country	:	US
Telephone Number	:	480-532-2035
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LUKE MILLER
Credential	:
Telephone Number	:	480-532-2035

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	10/12/2017

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Directions to “LGM DISTRIBUTION CORP. ” Practice Location

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