Provider Demographics
NPI:1063879252
Name:MEDCARE SUPPLY LLC
Entity type:Organization
Organization Name:MEDCARE SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KATU
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-428-9146
Mailing Address - Street 1:12195 HIGHWAY 92
Mailing Address - Street 2:SUITE 114-314
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3602
Mailing Address - Country:US
Mailing Address - Phone:800-528-8606
Mailing Address - Fax:
Practice Address - Street 1:3939 ROYAL DR NW
Practice Address - Street 2:SUITE 139
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6452
Practice Address - Country:US
Practice Address - Phone:800-528-8606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies