MEDICARE: CARLISLE MEDICAL 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	3336M0002X	Mail Order Pharmacy	64001925A	IN
2	3336M0002X	Mail Order Pharmacy	OSP0006045	CO
3	3336M0002X	Mail Order Pharmacy	PH25597	FL
4	3336M0002X	Mail Order Pharmacy	NRP1555	CA
5	3336M0002X	Mail Order Pharmacy	54.017913	IL
6	3336M0002X	Mail Order Pharmacy	PO6218	MD
7	3336M0002X	Mail Order Pharmacy	263934	MN
8	3336M0002X	Mail Order Pharmacy	PHY.005485-NR	LA
9	3336M0002X	Mail Order Pharmacy	A9-0001215	DE
10	3336M0002X	Mail Order Pharmacy	22-02973	KS
11	3336M0002X	Mail Order Pharmacy	5301009817	MI
12	3336M0002X	Mail Order Pharmacy	4201	IA
13	3336M0002X	Mail Order Pharmacy	PHNR000189	GA
14	3336M0002X	Mail Order Pharmacy	AL1513	KY
15	3336M0002X	Mail Order Pharmacy	102101	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1991543	OTHER		PK

General Provider Information

NPI Number	:	1881928000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLISLE MEDICAL INC

Provider Business Mailing Address
First Line	:	PO BOX 9814
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36691-0814
Country	:	US
Telephone Number	:	800-553-1783
Fax Number	:	855-451-5140

Provider Business Practice Location Address
First Line	:	509 BOULEVARD PARK E
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36609-3425
Country	:	US
Telephone Number	:	251-344-7988
Fax Number	:	251-343-7682

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	JEFF CARLISLE
Credential	:
Telephone Number	:	251-344-7988

Provider Enumeration Date	:	09/21/2009
Last Update Date	:	02/20/2017

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