MEDICARE: MUSSER ENTERPRISES 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	:	1598262800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSSER ENTERPRISES LLC

Provider Business Mailing Address
First Line	:	1012 E WASHINGTON ST APT 2108
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1080
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1012 E WASHINGTON ST APT 2108
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1080
Country	:	US
Telephone Number	:	480-935-6611
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BLAKE MUSSER
Credential	:
Telephone Number	:	480-935-6611

Provider Enumeration Date	:	04/12/2018
Last Update Date	:	04/12/2018

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Directions to “MUSSER ENTERPRISES LLC ” Practice Location

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