MEDICARE: EAST 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	:	1760008791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST MEDICAL LLC

Provider Business Mailing Address
First Line	:	401 CONGRESS AVE STE 1540
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-3851
Country	:	US
Telephone Number	:	214-770-2611
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 CONGRESS AVE STE 1540
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-3851
Country	:	US
Telephone Number	:	214-770-2611
Fax Number	:

Authorized Official
Title or Position	:	BILLER
Name	:	CAROL ANNE FULLER
Credential	:
Telephone Number	:	469-395-8402

Provider Enumeration Date	:	06/25/2020
Last Update Date	:	06/25/2020

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Directions to “EAST MEDICAL LLC ” Practice Location

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