MEDICARE: SCIENTECH MEDICAL SUPPLIES, 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	332BX2000X	Oxygen Equipment & Supplies (DME)	20016604261	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912900945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCIENTECH MEDICAL SUPPLIES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1635
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-8635
Country	:	US
Telephone Number	:	770-471-4888
Fax Number	:	770-471-4887

Provider Business Practice Location Address
First Line	:	7000 TARA BLVD
Second Line	:	SUITE F
City	:	JONESBORO
State	:	GA
Zip	:	30236-1600
Country	:	US
Telephone Number	:	770-417-4888
Fax Number	:	770-471-4887

Authorized Official
Title or Position	:	CEO
Name	:	MR. IYOBOSA O JESUOROBO
Credential	:	MBA
Telephone Number	:	770-471-4888

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/07/2010

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