MEDICARE: PROHEALTH RESOURCE GROUP, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548285422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH RESOURCE GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:	1300 EAST UNION ST
City	:	VIENNA
State	:	GA
Zip	:	31092-0549
Country	:	US
Telephone Number	:	229-268-7510
Fax Number	:	229-268-4716

Provider Business Practice Location Address
First Line	:	1300 E UNION ST
Second Line	:
City	:	VIENNA
State	:	GA
Zip	:	31092-7541
Country	:	US
Telephone Number	:	229-268-7510
Fax Number	:	229-268-4716

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	RICHARD E FALLAW SR.
Credential	:
Telephone Number	:	229-268-7510

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	09/24/2008

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Directions to “PROHEALTH RESOURCE GROUP, INC. ” Practice Location

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