MEDICARE: GALWAY TRADING 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	201214410215	CA

General Provider Information

NPI Number	:	1508258450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALWAY TRADING LLC

Provider Business Mailing Address
First Line	:	13101 W WASHINGTON BLVD
Second Line	:	#433
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5131
Country	:	US
Telephone Number	:	800-794-0763
Fax Number	:

Provider Business Practice Location Address
First Line	:	13101 W WASHINGTON BLVD
Second Line	:	#433
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5131
Country	:	US
Telephone Number	:	800-794-0763
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BERTRAND HAURE
Credential	:
Telephone Number	:	800-794-0763

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/02/2015

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