MEDICARE: MED-LINE SUPPORT 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	253Z00000X	In Home Supportive Care Agency	10733601	PA

General Provider Information

NPI Number	:	1750823050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-LINE SUPPORT INC

Provider Business Mailing Address
First Line	:	1514 ELECTRIC AVE
Second Line	:
City	:	EAST PITTSBURGH
State	:	PA
Zip	:	15112-1337
Country	:	US
Telephone Number	:	412-824-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1514 ELECTRIC AVE
Second Line	:
City	:	EAST PITTSBURGH
State	:	PA
Zip	:	15112-1337
Country	:	US
Telephone Number	:	412-824-0700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	MR. THOMAS DOMKE
Credential	:
Telephone Number	:	412-824-0700

Provider Enumeration Date	:	11/17/2016
Last Update Date	:	11/17/2016

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Directions to “MED-LINE SUPPORT INC ” Practice Location

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