MEDICARE: BASS RUTLEDGE DRUG DBA BENTLEY PHARMACY

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	0305	TX
2	332BX2000X	Oxygen Equipment & Supplies (DME)	0305	TX
3	332B00000X	Durable Medical Equipment & Medical Supplies	0305	TX

General Provider Information

NPI Number	:	1699968115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASS RUTLEDGE DRUG DBA BENTLEY PHARMACY

Provider Business Mailing Address
First Line	:	201 W MOORE AVE
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-3115
Country	:	US
Telephone Number	:	972-563-3327
Fax Number	:	972-563-5808

Provider Business Practice Location Address
First Line	:	201 W MOORE AVE
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-3115
Country	:	US
Telephone Number	:	972-563-3327
Fax Number	:	972-563-5808

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FRED BENTLEY
Credential	:	RPH
Telephone Number	:	972-563-3327

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	08/20/2007

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