MEDICARE: PLAZA HOME INFUSION SERVICE

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	333600000X	Pharmacy	13131	TX

General Provider Information

NPI Number	:	1184623076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA HOME INFUSION SERVICE

Provider Business Mailing Address
First Line	:	315 E CALIFORNIA ST
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-4005
Country	:	US
Telephone Number	:	940-665-5348
Fax Number	:	940-665-8682

Provider Business Practice Location Address
First Line	:	315 E CALIFORNIA ST
Second Line	:
City	:	GAINESVILLE
State	:	TX
Zip	:	76240-4005
Country	:	US
Telephone Number	:	940-665-5348
Fax Number	:	940-665-8682

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	MR. JERRY D MEECE
Credential	:	R.PH.
Telephone Number	:	940-665-5348

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/20/2007

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