MEDICARE: JANE A PRATT DBA NEW BEGINNINGS

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	94722	OTHER	AL	BLUE CROSS BLUE SHIELD
2	22996	OTHER		PRINCIPAL HEALTH
3	81731	OTHER		NORTHWOOD
4	R9474	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1487634358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE A PRATT DBA NEW BEGINNINGS

Provider Business Mailing Address
First Line	:	219 CREWILLA DR NW
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-3947
Country	:	US
Telephone Number	:	850-581-7700
Fax Number	:	850-244-5342

Provider Business Practice Location Address
First Line	:	219 CREWILLA DR NW
Second Line	:
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32548-3947
Country	:	US
Telephone Number	:	850-581-7700
Fax Number	:	850-244-5342

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JANE A PRATT
Credential	:	CFM
Telephone Number	:	850-581-7700

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	10/23/2007

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