MEDICARE: PRO-MEDICAL EQUIPMENT, CORP.

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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)

General Provider Information

NPI Number	:	1750485454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO-MEDICAL EQUIPMENT, CORP.

Provider Business Mailing Address
First Line	:	PO BOX 2071
Second Line	:
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-8071
Country	:	US
Telephone Number	:	787-280-5031
Fax Number	:	787-280-5036

Provider Business Practice Location Address
First Line	:	CARR 446 KM 0.3
Second Line	:	BO. GUATEMALA
City	:	SAN SEBASTIAN
State	:	PR
Zip	:	00685-4460
Country	:	US
Telephone Number	:	787-896-2272
Fax Number	:	787-280-1040

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. IVY ENID ROMAN IRIZARRY
Credential	:
Telephone Number	:	787-922-4170

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	05/06/2008

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