MEDICARE: PARKER HEALTHCARE PRODUCTS, 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)	1452	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R9714	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1790747822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKER HEALTHCARE PRODUCTS, INC.

Provider Business Mailing Address
First Line	:	1112 W NEW HAVEN AVE
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-4056
Country	:	US
Telephone Number	:	321-956-4000
Fax Number	:	321-726-0972

Provider Business Practice Location Address
First Line	:	1112 W NEW HAVEN AVE
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-4056
Country	:	US
Telephone Number	:	321-956-4000
Fax Number	:	321-726-0972

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SHAWN PARKER
Credential	:
Telephone Number	:	321-956-4000

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/24/2007

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