MEDICARE: ENCOMPASS 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	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1578844650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCOMPASS MEDICAL, LLC

Provider Business Mailing Address
First Line	:	4128 CROSSHAVEN DRIVE
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35243-5228
Country	:	US
Telephone Number	:	205-969-7466
Fax Number	:	205-969-1600

Provider Business Practice Location Address
First Line	:	4128 CROSSHAVEN DRIVE
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35243-5228
Country	:	US
Telephone Number	:	205-969-7466
Fax Number	:	205-969-1600

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. JACK N DUNN JR.
Credential	:
Telephone Number	:	205-969-7466

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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