MEDICARE: MARLENE'S HOME MEDICAL EQUIPMENT & SUPPLIES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	TX
2	332BX2000X	Oxygen Equipment & Supplies (DME)	TX
3	332BC3200X	Customized Equipment (DME)	TX

General Provider Information

NPI Number	:	1548558752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARLENE'S HOME MEDICAL EQUIPMENT & SUPPLIES LLC

Provider Business Mailing Address
First Line	:	1765 S AVONDALE ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-4516
Country	:	US
Telephone Number	:	806-418-4609
Fax Number	:	806-418-4612

Provider Business Practice Location Address
First Line	:	1765 S AVONDALE ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79106-4516
Country	:	US
Telephone Number	:	806-418-4609
Fax Number	:	806-418-4612

Authorized Official
Title or Position	:	OWNER
Name	:	MISS MELINDA WILLIAMS
Credential	:
Telephone Number	:	806-418-4609

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	07/21/2011

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