MEDICARE: PEST ELIMINATORS 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	332BC3200X	Customized Equipment (DME)	JE80536	FL

General Provider Information

NPI Number	:	1598160988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEST ELIMINATORS INC.

Provider Business Mailing Address
First Line	:	3314 HARBOR BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8004
Country	:	US
Telephone Number	:	941-766-0902
Fax Number	:	941-766-0904

Provider Business Practice Location Address
First Line	:	3314 HARBOR BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8004
Country	:	US
Telephone Number	:	941-766-0902
Fax Number	:	941-766-0904

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CONRAD ESTREM BURNS SR.
Credential	:
Telephone Number	:	941-766-0902

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/28/2014

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