MEDICARE: MCPHERSON PEST CONTROL

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	332U00000X	Home Delivered Meals	JB122390	FL

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	:	1699103820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCPHERSON PEST CONTROL

Provider Business Mailing Address
First Line	:	7979A SHADY GROVE ROAD
Second Line	:
City	:	GRAND RIDGE
State	:	FL
Zip	:	32442
Country	:	US
Telephone Number	:	850-593-5674
Fax Number	:	850-593-0583

Provider Business Practice Location Address
First Line	:	7979A SHADY GROVE ROAD
Second Line	:
City	:	GRAND RIDGE
State	:	FL
Zip	:	32442-3815
Country	:	US
Telephone Number	:	850-593-5674
Fax Number	:	850-593-0583

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JERRY MARTIN MCPHERSON I
Credential	:
Telephone Number	:	850-593-5674

Provider Enumeration Date	:	10/25/2013
Last Update Date	:	10/25/2013

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