MEDICARE: DAVID PETSCH ENTERPRISES, 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)	20012830780	GA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861487373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID PETSCH ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	3845 MARTINEZ BLVD
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-2666
Country	:	US
Telephone Number	:	706-863-6252
Fax Number	:	706-863-2337

Provider Business Practice Location Address
First Line	:	3845 MARTINEZ BLVD
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-2666
Country	:	US
Telephone Number	:	706-863-6252
Fax Number	:	706-863-2337

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHADWICK KEEBLE MCCRICKARD
Credential	:
Telephone Number	:	706-863-6252

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	06/11/2021

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