MEDICARE: PROFESSIONAL MEDICAL WAREHOUSE, 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

General Provider Information

NPI Number	:	1376854430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL MEDICAL WAREHOUSE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 5785
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92263
Country	:	US
Telephone Number	:	760-325-9400
Fax Number	:	760-325-6438

Provider Business Practice Location Address
First Line	:	1775 E PALM CANYON DR
Second Line	:	SUITE #335
City	:	PALM SPRINGS
State	:	CA
Zip	:	92264-1613
Country	:	US
Telephone Number	:	760-325-9400
Fax Number	:	760-325-6438

Authorized Official
Title or Position	:	MANGER
Name	:	MR. STEVE DAVIS
Credential	:
Telephone Number	:	760-325-9400

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	11/29/2010

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