MEDICARE: HARBOR MEDICAL EQUIPMENT, 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	1001512	TX

General Provider Information

NPI Number	:	1528452646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR MEDICAL EQUIPMENT, LLC

Provider Business Mailing Address
First Line	:	2101 E SAINT ELMO RD BLDG 2
Second Line	:	SUITE 275
City	:	AUSTIN
State	:	TX
Zip	:	78744-1863
Country	:	US
Telephone Number	:	512-326-3244
Fax Number	:	512-326-3299

Provider Business Practice Location Address
First Line	:	2101 E SAINT ELMO RD BLDG 2
Second Line	:	SUITE 275
City	:	AUSTIN
State	:	TX
Zip	:	78744-1863
Country	:	US
Telephone Number	:	512-326-3244
Fax Number	:	512-326-3299

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. DAVID SHOCKLEY
Credential	:
Telephone Number	:	512-326-3244

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	09/10/2015

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