MEDICARE: CAPCITY MEDSUPPLY, 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	:	1609011527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPCITY MEDSUPPLY, LLC

Provider Business Mailing Address
First Line	:	1868 PARADISE RIDGE DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-5628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1868 PARADISE RIDGE DR
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-5628
Country	:	US
Telephone Number	:	512-497-7107
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEREK JOHNSON
Credential	:
Telephone Number	:	512-497-7107

Provider Enumeration Date	:	12/05/2008
Last Update Date	:	12/05/2008

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