MEDICARE: WEBB KOHLER MEDICAL EQUIPMENT AND SUPPLY

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	0040686	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10023587	OTHER	TX	AMERIGROUP
2	1812371000	OTHER	TX	ACS US DEPT OF LABOR

General Provider Information

NPI Number	:	1770619405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEBB KOHLER MEDICAL EQUIPMENT AND SUPPLY

Provider Business Mailing Address
First Line	:	PO BOX 173189
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-3189
Country	:	US
Telephone Number	:	817-861-4631
Fax Number	:	817-861-4638

Provider Business Practice Location Address
First Line	:	2204 PARK SPRINGS BLVD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013
Country	:	US
Telephone Number	:	817-861-4631
Fax Number	:	817-861-4638

Authorized Official
Title or Position	:	CEO PIC
Name	:	MS. PAULETTE MARIE SALVANT
Credential	:	RPH
Telephone Number	:	817-861-4631

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	12/21/2007

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Directions to “WEBB KOHLER MEDICAL EQUIPMENT AND SUPPLY ” Practice Location

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