MEDICARE: EXALTA 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	6000008575	PA

General Provider Information

NPI Number	:	1831595693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXALTA MEDICAL LLC

Provider Business Mailing Address
First Line	:	1753 SPRING HOUSE RD
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-1425
Country	:	US
Telephone Number	:	610-563-0421
Fax Number	:

Provider Business Practice Location Address
First Line	:	1753 SPRING HOUSE RD
Second Line	:
City	:	CHESTER SPRINGS
State	:	PA
Zip	:	19425-1425
Country	:	US
Telephone Number	:	610-563-0421
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GERALD M MAKOID
Credential	:
Telephone Number	:	610-563-0421

Provider Enumeration Date	:	11/06/2014
Last Update Date	:	11/06/2014

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