MEDICARE: MAXIM MEDICAL SUPPLIES 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	:	1750095162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAXIM MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	18800 PRESTON RD STE 306
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-8573
Country	:	US
Telephone Number	:	214-299-9599
Fax Number	:

Provider Business Practice Location Address
First Line	:	18800 PRESTON RD STE 306
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-8573
Country	:	US
Telephone Number	:	214-299-9599
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	AMMAR ALFARAWATI
Credential	:
Telephone Number	:	469-766-4948

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	02/21/2024

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Directions to “MAXIM MEDICAL SUPPLIES LLC ” Practice Location

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