MEDICARE: EXCEL DURABLE MEDICAL EQUIPMENT, 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	:	1821302613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL DURABLE MEDICAL EQUIPMENT, LLC

Provider Business Mailing Address
First Line	:	3418 HANDY RD
Second Line	:	SUITE 104
City	:	TAMPA
State	:	FL
Zip	:	33618-4603
Country	:	US
Telephone Number	:	813-443-0638
Fax Number	:	813-443-0639

Provider Business Practice Location Address
First Line	:	3418 HANDY RD
Second Line	:	SUITE 104
City	:	TAMPA
State	:	FL
Zip	:	33618-4603
Country	:	US
Telephone Number	:	813-443-0638
Fax Number	:	813-443-0639

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DANIEL JIMENEZ JR.
Credential	:	RN
Telephone Number	:	813-443-0638

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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