MEDICARE: MLS 1116 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

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	:	1922038561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MLS 1116 INC

Provider Business Mailing Address
First Line	:	702 COLUMBIA HWY
Second Line	:
City	:	GREENSBURG
State	:	KY
Zip	:	42743-1118
Country	:	US
Telephone Number	:	270-973-5276
Fax Number	:	270-973-5267

Provider Business Practice Location Address
First Line	:	702 COLUMBIA HWY
Second Line	:
City	:	GREENSBURG
State	:	KY
Zip	:	42743-1118
Country	:	US
Telephone Number	:	270-973-5276
Fax Number	:	270-973-5267

Authorized Official
Title or Position	:	OWNER MANAGER
Name	:	SAMMY BLAKEMAN JR.
Credential	:
Telephone Number	:	270-634-0534

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	08/02/2019

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Directions to “MLS 1116 INC ” Practice Location

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