MEDICARE: PET RHINO 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	332B00000X	Durable Medical Equipment & Medical Supplies	1313414	FL
2	332BC3200X	Customized Equipment (DME)	1313414	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
2	R001U	OTHER	FL	BCBSFL

General Provider Information

NPI Number	:	1851695365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PET RHINO INC

Provider Business Mailing Address
First Line	:	5008 W LINEBAUGH AVE
Second Line	:	STE 9
City	:	TAMPA
State	:	FL
Zip	:	33624-5095
Country	:	US
Telephone Number	:	813-908-5302
Fax Number	:	813-908-7013

Provider Business Practice Location Address
First Line	:	5008 W LINEBAUGH AVE
Second Line	:	STE 9
City	:	TAMPA
State	:	FL
Zip	:	33624-5095
Country	:	US
Telephone Number	:	813-908-5302
Fax Number	:	813-908-7013

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSEPH WILLIAM KELLEY
Credential	:
Telephone Number	:	813-908-5302

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	06/09/2011

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Directions to “PET RHINO INC ” Practice Location

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