MEDICARE: PROSTHETIC CENTER OF PASCO 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	335E00000X	Prosthetic/Orthotic Supplier	PRO6	FL

General Provider Information

NPI Number	:	1366504425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETIC CENTER OF PASCO INC

Provider Business Mailing Address
First Line	:	5950 HIGH STREET
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4149
Country	:	US
Telephone Number	:	727-846-8124
Fax Number	:	727-846-7109

Provider Business Practice Location Address
First Line	:	5950 HIGH STREET
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4149
Country	:	US
Telephone Number	:	727-846-8124
Fax Number	:	727-846-7109

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MR. PAUL D MCCULLOUGH
Credential	:	CP
Telephone Number	:	727-846-8124

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	08/22/2020

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