MEDICARE: NATIONAL DURABLE MEDICAL EQUIPMENT

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
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1467896068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL DURABLE MEDICAL EQUIPMENT

Provider Business Mailing Address
First Line	:	PO BOX 367
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-9998
Country	:	US
Telephone Number	:	800-644-1968
Fax Number	:	801-566-3782

Provider Business Practice Location Address
First Line	:	7010 E. ADAMO DRIVE BLD. C UNIT 3
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-3417
Country	:	US
Telephone Number	:	800-644-1968
Fax Number	:	801-566-3782

Authorized Official
Title or Position	:	CEO
Name	:	J. SCOTT COTTIS
Credential	:
Telephone Number	:	800-644-1968

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	04/25/2013

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