MEDICARE: WILLOW MEDICAL 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	:	1548697428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW MEDICAL LLC

Provider Business Mailing Address
First Line	:	6409 WILLOW LN
Second Line	:
City	:	MISSION HILLS
State	:	KS
Zip	:	66208-1958
Country	:	US
Telephone Number	:	913-706-6208
Fax Number	:	913-523-0482

Provider Business Practice Location Address
First Line	:	7329 W 97TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66212-2210
Country	:	US
Telephone Number	:	913-538-5269
Fax Number	:	913-538-5690

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY BURGESS
Credential	:
Telephone Number	:	913-706-6208

Provider Enumeration Date	:	10/09/2013
Last Update Date	:	10/09/2013

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Directions to “WILLOW MEDICAL LLC ” Practice Location

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