MEDICARE: BASIC MEDICAL SUPPLIES, INC

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	:	1538450481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASIC MEDICAL SUPPLIES, INC

Provider Business Mailing Address
First Line	:	26814 N 24TH LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-8741
Country	:	US
Telephone Number	:	480-335-6112
Fax Number	:	480-626-2923

Provider Business Practice Location Address
First Line	:	2316 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-1850
Country	:	US
Telephone Number	:	480-335-6112
Fax Number	:	480-626-2923

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GEOFFREY CHAM BOADU
Credential	:
Telephone Number	:	480-335-6112

Provider Enumeration Date	:	04/27/2011
Last Update Date	:	04/27/2011

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