MEDICARE: ROBERT TWADDELL

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		NC

General Provider Information

NPI Number	:	1649588997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT TWADDELL

Provider Business Mailing Address
First Line	:	1248 FORT BRAGG RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-4981
Country	:	US
Telephone Number	:	910-486-9511
Fax Number	:	910-728-4868

Provider Business Practice Location Address
First Line	:	1248 FORT BRAGG RD
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-4981
Country	:	US
Telephone Number	:	910-486-9511
Fax Number	:	910-728-4868

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT W TWADDELL
Credential	:	DC
Telephone Number	:	910-486-9511

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	09/21/2010

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