MEDICARE: TEN 20 MEDICAL DISTRIBUTION 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	174400000X	Specialist

General Provider Information

NPI Number	:	1518211143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEN 20 MEDICAL DISTRIBUTION LLC

Provider Business Mailing Address
First Line	:	4300 SIGMA RD
Second Line	:	STE 120
City	:	DALLAS
State	:	TX
Zip	:	75244-4422
Country	:	US
Telephone Number	:	214-483-9933
Fax Number	:	214-483-9944

Provider Business Practice Location Address
First Line	:	4300 SIGMA RD STE 120
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-4422
Country	:	US
Telephone Number	:	214-483-9933
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JASON PAPES
Credential	:
Telephone Number	:	214-483-9933

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	09/10/2014

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