MEDICARE: DIRECTED MEDICAL 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	:	1740828920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECTED MEDICAL LLC

Provider Business Mailing Address
First Line	:	393 BOUNTY WAY
Second Line	:
City	:	AVON LAKE
State	:	OH
Zip	:	44012-2431
Country	:	US
Telephone Number	:	440-823-3436
Fax Number	:

Provider Business Practice Location Address
First Line	:	20800 CENTER RIDGE RD STE 324
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-4306
Country	:	US
Telephone Number	:	440-823-3436
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY FALLON
Credential	:
Telephone Number	:	440-823-3436

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	12/18/2019

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