MEDICARE: BOLTON HEALTHCARE, 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	332BC3200X	Customized Equipment (DME)	0085042	TX
2	332BD1200X	Dialysis Equipment & Supplies (DME)	0085042	TX
3	332BN1400X	Nursing Facility Supplies (DME)	0085042	TX
4	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	0085042	TX
5	332BX2000X	Oxygen Equipment & Supplies (DME)	0085042	TX
6	332B00000X	Durable Medical Equipment & Medical Supplies	0085042	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1194755991	OTHER	TX	OLD NPI

General Provider Information

NPI Number	:	1598921124
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOLTON HEALTHCARE, L.L.C.

Provider Business Mailing Address
First Line	:	12627 HIGHWAY 6
Second Line	:
City	:	SANTA FE
State	:	TX
Zip	:	77510-7613
Country	:	US
Telephone Number	:	409-925-7303
Fax Number	:

Provider Business Practice Location Address
First Line	:	12627 HIGHWAY 6
Second Line	:
City	:	SANTA FE
State	:	TX
Zip	:	77510-7613
Country	:	US
Telephone Number	:	409-925-7303
Fax Number	:

Authorized Official
Title or Position	:	DME ASSITANT ADMINISTRATOR
Name	:	MRS. KAREN MARIE ALLEN
Credential	:
Telephone Number	:	409-925-7303

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	12/09/2008

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Directions to “BOLTON HEALTHCARE, L.L.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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