MEDICARE: BROSCO INTERNATIONAL INC

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	0038660	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7735450001	OTHER	TX	PTAN

General Provider Information

NPI Number	:	1508882317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROSCO INTERNATIONAL INC

Provider Business Mailing Address
First Line	:	925 N BRYAN BELT LINE RD STE 105
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-2541
Country	:	US
Telephone Number	:	972-329-5555
Fax Number	:	972-692-8245

Provider Business Practice Location Address
First Line	:	925 N BRYAN BELT LINE RD STE 105
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75149-2541
Country	:	US
Telephone Number	:	972-329-5555
Fax Number	:	972-329-0008

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN T MANIYATT
Credential	:
Telephone Number	:	972-329-5555

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	05/06/2019

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