MEDICARE: PR ACQUISITION CORPORATION

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

General Provider Information

NPI Number	:	1922279918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PR ACQUISITION CORPORATION

Provider Business Mailing Address
First Line	:	4716 GETTYSBURG RD
Second Line	:	LEGAL DEPARTMENT
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-975-4503
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	1341 S RAINBOW BLVD
Second Line	:	STE 201
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9069
Country	:	US
Telephone Number	:	717-975-4503
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL TARVIN
Credential	:
Telephone Number	:	717-975-4503

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/18/2008

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Directions to “PR ACQUISITION CORPORATION ” Practice Location

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