MEDICARE: SACRAMENTO MED 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	:	1841847795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRAMENTO MED LLC

Provider Business Mailing Address
First Line	:	5301 ALPHA RD STE E80
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4355
Country	:	US
Telephone Number	:	214-613-5739
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 ALPHA RD STE E80
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-4355
Country	:	US
Telephone Number	:	214-613-5739
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SYYED ALI
Credential	:
Telephone Number	:	214-613-5739

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	08/28/2019

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