MEDICARE: BRADSHAW HOME MEDICAL EQUIPMENT LLC.

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)	20102224	AZ

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	:	1790741569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADSHAW HOME MEDICAL EQUIPMENT LLC.

Provider Business Mailing Address
First Line	:	9350 E VALLEY RD
Second Line	:	STE C.
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-2328
Country	:	US
Telephone Number	:	928-775-8282
Fax Number	:	928-775-8869

Provider Business Practice Location Address
First Line	:	9350 E VALLEY RD
Second Line	:	STE C.
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-2328
Country	:	US
Telephone Number	:	928-775-8282
Fax Number	:	928-775-8869

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. ROBERT KELLER
Credential	:
Telephone Number	:	928-775-8282

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	01/21/2015

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