MEDICARE: TAYLOR MADE WALK IN TUBS 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1497373989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAYLOR MADE WALK IN TUBS LLC

Provider Business Mailing Address
First Line	:	420 NICHOLS RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-2005
Country	:	US
Telephone Number	:	913-208-4607
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 NICHOLS RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-2005
Country	:	US
Telephone Number	:	913-208-4607
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER TAYLOR
Credential	:
Telephone Number	:	913-671-0441

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	07/10/2020

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