MEDICARE: MELINDA'S MEDICAL SUPPLY

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	332BX2000X	Oxygen Equipment & Supplies (DME)	02-376273-00 0	NM

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
2	1023506	OTHER	NM	ACM

General Provider Information

NPI Number	:	1497719769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MELINDA'S MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	910 E 32ND ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7205
Country	:	US
Telephone Number	:	575-534-4013
Fax Number	:	575-534-4016

Provider Business Practice Location Address
First Line	:	910 E 32ND ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7205
Country	:	US
Telephone Number	:	575-534-4013
Fax Number	:	575-534-4016

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MELINDA BARTLETT
Credential	:
Telephone Number	:	575-534-4013

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	10/14/2008

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Directions to “MELINDA'S MEDICAL SUPPLY ” Practice Location

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