MEDICARE: IMC-HEARTWAY, L.L.C.

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	:	1548629413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMC-HEARTWAY, L.L.C.

Provider Business Mailing Address
First Line	:	5681 INDEPENDENCE CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4457
Country	:	US
Telephone Number	:	239-275-6767
Fax Number	:	239-275-7033

Provider Business Practice Location Address
First Line	:	5681 INDEPENDENCE CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4457
Country	:	US
Telephone Number	:	239-275-6767
Fax Number	:	239-275-7033

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. HONG-AN LIN
Credential	:
Telephone Number	:	239-275-6767

Provider Enumeration Date	:	02/19/2016
Last Update Date	:	02/19/2016

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