Provider Demographics
NPI:1790747822
Name:PARKER HEALTHCARE PRODUCTS, INC.
Entity Type:Organization
Organization Name:PARKER HEALTHCARE PRODUCTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-956-4000
Mailing Address - Street 1:1112 W NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-4056
Mailing Address - Country:US
Mailing Address - Phone:321-956-4000
Mailing Address - Fax:321-726-0972
Practice Address - Street 1:1112 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4056
Practice Address - Country:US
Practice Address - Phone:321-956-4000
Practice Address - Fax:321-726-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1452332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9714OtherBCBS
FL4198580001Medicare ID - Type Unspecified