MEDICARE: MID-CITIES HOME MEDICAL EQUIPMENT CO. INC.

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	0010654	TX
2	332BX2000X	Oxygen Equipment & Supplies (DME)	0036337	TX
3	332BX2000X	Oxygen Equipment & Supplies (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	531150	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1699831131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-CITIES HOME MEDICAL EQUIPMENT CO. INC.

Provider Business Mailing Address
First Line	:	304 RED HAWK DR.
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052
Country	:	US
Telephone Number	:	972-641-7445
Fax Number	:	972-641-7465

Provider Business Practice Location Address
First Line	:	2112 RUTLAND DR
Second Line	:	STE 176
City	:	AUSTIN
State	:	TX
Zip	:	78758
Country	:	US
Telephone Number	:	512-837-2533
Fax Number	:	512-837-0135

Authorized Official
Title or Position	:	OPERATIONS MGR.
Name	:	BRIAN MONTHEY
Credential	:
Telephone Number	:	972-641-7445

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/31/2008

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