Provider Demographics
NPI:1609984970
Name:PRO HOME MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:PRO HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:PHYSICAL REHAB PRODUCTS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:941-365-1499
Mailing Address - Street 1:2187 SIESTA DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-5235
Mailing Address - Country:US
Mailing Address - Phone:941-365-1499
Mailing Address - Fax:941-365-3929
Practice Address - Street 1:2187 SIESTA DRIVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-365-1499
Practice Address - Fax:941-365-3929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL911332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM2395OtherBCBS
FL026523300Medicaid
FL1134730001Medicare NSC