MEDICARE: ANTELOPE WORKS, 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
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1528675469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTELOPE WORKS, LLC

Provider Business Mailing Address
First Line	:	24 W CAMELBACK RD # A586
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2529
Country	:	US
Telephone Number	:	602-456-6896
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 N 3RD ST STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1145
Country	:	US
Telephone Number	:	602-456-6896
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MS. ANNETTE ZINKY
Credential	:
Telephone Number	:	602-456-6896

Provider Enumeration Date	:	09/24/2020
Last Update Date	:	09/24/2020

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Directions to “ANTELOPE WORKS, LLC ” Practice Location

Language	Start Address	Practice Location

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