MEDICARE: MEDICAL HOMECARE SUPPLY, 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	332B00000X	Durable Medical Equipment & Medical Supplies	407	FL

General Provider Information

NPI Number	:	1770509804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL HOMECARE SUPPLY, INC.

Provider Business Mailing Address
First Line	:	640 NORTHLAKE BLVD
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5309
Country	:	US
Telephone Number	:	561-842-3708
Fax Number	:	561-842-6264

Provider Business Practice Location Address
First Line	:	640 NORTHLAKE BLVD
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-5309
Country	:	US
Telephone Number	:	561-842-3708
Fax Number	:	561-842-6464

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MAURICE J LECKER
Credential	:
Telephone Number	:	561-965-2785

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/30/2009

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