MEDICARE: PEKIN PROHEALTH 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	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1538113535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEKIN PROHEALTH INC.

Provider Business Mailing Address
First Line	:	1416 N 8TH ST
Second Line	:
City	:	PEKIN
State	:	IL
Zip	:	61554-2103
Country	:	US
Telephone Number	:	309-347-4663
Fax Number	:	309-347-5127

Provider Business Practice Location Address
First Line	:	710 ILLINOIS AVE
Second Line	:
City	:	MENDOTA
State	:	IL
Zip	:	61342-1638
Country	:	US
Telephone Number	:	815-539-6506
Fax Number	:	815-539-6708

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. SCOTT LEIGH HAYNES
Credential	:
Telephone Number	:	309-347-4663

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	08/22/2020

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