Medicare / Medicaid Program Information - HCFA Contractual Information – (HCFA form 855 (1/98) 

To Whom It May Concern:

RE: HCFA Contractual Information – (HCFA form 855 (1/98)

Medtronic ENT Surgical Products, Inc. is not a contractor registered with the US Federal Medicare/Medicaid program. Medtronic ENT is solely engaged in the business of supplying surgical equipment and medical supplies to healthcare provider facilities.

Medtronic ENT does not accept any direct Medicare/Medicaid billing, nor does it accept any reassignment of program benefits from healthcare facilities or any institutional healthcare providers who are contracted with or who are applying for contract with the US Federal Medicare/Medicaid program.

Furthermore, Medtronic ENT has not been levied with any penalties by the US Medicare/Medicaid program.

Should determination by any applicant healthcare provider require information on suppliers of medical supplies, this letter contains the necessary Medtronic ENT business information for completing the Medicare/Medicaid HCFA 855 Form:

Legal name of Business:
Medtronic ENT Surgical Products, Inc.

Doing Business As:
Medtronic ENT, Merocel Surgical Products, Medtronic Ophthalmics
Address:
6743 Southpoint Dr. N
Jacksonville, Florida 32216-0980 USA

Federal Employee Identification Number:
06-1393528
Telephone:
(904) 296-9600 FAX (800) 678-3995

Sincerely,
Medtronic ENT Surgical Products, Inc.
March, 1999