MEDICARE: PEDIATRIC MEDICAL SUPPLY, 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	:	1396969978
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	2511 BROWNCROFT BLVD
Second Line	:	SUITE 101
City	:	ROCHESTER
State	:	NY
Zip	:	14625-1513
Country	:	US
Telephone Number	:	585-381-3060
Fax Number	:	585-381-3064

Provider Business Practice Location Address
First Line	:	2511 BROWNCROFT BLVD
Second Line	:	SUITE 101
City	:	ROCHESTER
State	:	NY
Zip	:	14625-1513
Country	:	US
Telephone Number	:	585-381-3060
Fax Number	:	585-381-3064

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PETER R. CAINES
Credential	:
Telephone Number	:	585-381-3060

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	03/04/2013

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