MEDICARE: MEDCO RESPIRATORY INSTRUMENTS, 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1548618101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDCO RESPIRATORY INSTRUMENTS, INC

Provider Business Mailing Address
First Line	:	2460 E GERMANN RD STE 18
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-1573
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5731 RITTIMAN PLZ BLDG 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-5220
Country	:	US
Telephone Number	:	800-245-3816
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. ALLEN CHARLESWORTH
Credential	:	CPA
Telephone Number	:	480-883-1188

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	05/24/2016

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