MEDICARE: CAL CITY MEDICAL SUPPLY, 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	332B00000X	Durable Medical Equipment & Medical Supplies	1156	AL

General Provider Information

NPI Number	:	1902241011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAL CITY MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	6218 RINGGOLD RD
Second Line	:
City	:	EAST RIDGE
State	:	TN
Zip	:	37412-3849
Country	:	US
Telephone Number	:	800-474-5030
Fax Number	:	334-363-2786

Provider Business Practice Location Address
First Line	:	6218 RINGGOLD RD
Second Line	:
City	:	EAST RIDGE
State	:	TN
Zip	:	37412-3849
Country	:	US
Telephone Number	:	800-474-5030
Fax Number	:	334-363-2786

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAX LEVINE
Credential	:
Telephone Number	:	800-474-5030

Provider Enumeration Date	:	05/02/2013
Last Update Date	:	05/02/2013

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