MEDICARE: CAVE CITY RX CENTER

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

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	000000070098	OTHER	KY	DME

General Provider Information

NPI Number	:	1962400432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAVE CITY RX CENTER

Provider Business Mailing Address
First Line	:	PO BOX 596
Second Line	:
City	:	CAVE CITY
State	:	KY
Zip	:	42127-0596
Country	:	US
Telephone Number	:	270-773-2252
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S DIXIE HWY
Second Line	:
City	:	CAVE CITY
State	:	KY
Zip	:	42127-0596
Country	:	US
Telephone Number	:	270-773-2252
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MIKE BRANSTETTER
Credential	:	RPH
Telephone Number	:	270-773-2252

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/27/2008

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Directions to “CAVE CITY RX CENTER ” Practice Location

Language	Start Address	Practice Location

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