MEDICARE: SERVITIUM MED, 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	:	1689106684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVITIUM MED, LLC

Provider Business Mailing Address
First Line	:	501 SILVERSIDE RD
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19809-1374
Country	:	US
Telephone Number	:	855-210-4002
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 SILVERSIDE RD
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19809-1374
Country	:	US
Telephone Number	:	855-210-4002
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NEIL FRANCIS COSTELLO
Credential	:
Telephone Number	:	877-570-5531

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	04/27/2017

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