MEDICARE: MJB MEDICAL SUPPLIES, 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	:	1881935021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MJB MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	4220 HARLANWOOD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 HARLANWOOD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-2045
Country	:	US
Telephone Number	:	817-687-9727
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MICHAEL RANELLE
Credential	:
Telephone Number	:	817-687-9727

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	03/13/2013

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