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NPI Code Detail

MEDICARE: MBW700

MEDICARE: MBW700
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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1518547728
Entity Type Code : Organization
Provider Name (Legal Business Name) : MBW700
Provider Business Mailing Address
First Line : 11319 S HARLEM AVE
Second Line :
City : WORTH
State : IL
Zip : 60482-2001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11319 S HARLEM AVE
Second Line :
City : WORTH
State : IL
Zip : 60482-2001
Country : US
Telephone Number : 913-526-5282
Fax Number :
Authorized Official
Title or Position : AUTHORIZED AGENT
Name : KERI TARANTINO
Credential :
Telephone Number : 913-526-5282
Provider Enumeration Date : 04/12/2021
Last Update Date : 04/12/2021

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Directions to “MBW700 ” Practice Location

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