MEDICARE: LCB MEDICAL SUPPLIES, 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

General Provider Information

NPI Number	:	1538028501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LCB MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	4200 SOUTH FWY STE 2305
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1427
Country	:	US
Telephone Number	:	817-664-0999
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 SOUTH FWY STE 2305
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1427
Country	:	US
Telephone Number	:	817-664-0999
Fax Number	:

Authorized Official
Title or Position	:	PRESIDEN/CEO
Name	:	LUKE D BANNER
Credential	:
Telephone Number	:	817-664-0999

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/27/2026

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