MEDICARE: WRENN MEDICAL SUPPLY

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	0057283	TX

General Provider Information

NPI Number	:	1740354703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WRENN MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	2834 SE LOOP 820
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-1018
Country	:	US
Telephone Number	:	817-568-1112
Fax Number	:	817-568-8306

Provider Business Practice Location Address
First Line	:	2834 SE LOOP 820
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-1018
Country	:	US
Telephone Number	:	817-568-1112
Fax Number	:	817-568-8306

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DARRELL SHAW WRENN
Credential	:
Telephone Number	:	817-568-1112

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/22/2020

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