MEDICARE: PATRICIA JANE ELLER CMF

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)		NC

General Provider Information

NPI Number	:	1629504386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA JANE ELLER CMF

Provider Business Mailing Address
First Line	:	160 STARLIGHT DR
Second Line	:
City	:	LILLINGTON
State	:	NC
Zip	:	27546-7371
Country	:	US
Telephone Number	:	910-658-7656
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 PARK AVE
Second Line	:
City	:	SANFORD
State	:	NC
Zip	:	27330-4027
Country	:	US
Telephone Number	:	919-775-2001
Fax Number	:	919-776-8122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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