MEDICARE: PHYLLIS BORGARDT & ASSC., 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	332B00000X	CA

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
2	43293	OTHER	CA	HOME MEDICAL DEVICE

General Provider Information

NPI Number	:	1952350043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYLLIS BORGARDT & ASSC., INC.

Provider Business Mailing Address
First Line	:	191 S OAK PARK BLVD
Second Line	:
City	:	GROVER BEACH
State	:	CA
Zip	:	93433-2265
Country	:	US
Telephone Number	:	805-489-9335
Fax Number	:	805-489-9327

Provider Business Practice Location Address
First Line	:	191 S OAK PARK BLVD
Second Line	:	SUITE #5
City	:	GROVER BEACH
State	:	CA
Zip	:	93433-2265
Country	:	US
Telephone Number	:	805-489-9335
Fax Number	:	805-489-9327

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. PHYLLIS L BORGARDT
Credential	:	OTR-L
Telephone Number	:	805-489-9335

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	08/22/2020

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