1578724118 NPI number — FLORIDA HOME MEDICAL SUPPLY INC

Table of content: (NPI 1578724118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578724118 NPI number — FLORIDA HOME MEDICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA HOME MEDICAL SUPPLY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578724118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
614 E ALTAMONTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32701-4803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-849-6455
Provider Business Mailing Address Fax Number:
407-849-6458

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
724 S US HIGHWAY 441
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LADY LAKE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32159-4540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-849-6455
Provider Business Practice Location Address Fax Number:
407-849-6458
Provider Enumeration Date:
06/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRUINSMA
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/ GENERAL MANAGER
Authorized Official Telephone Number:
407-849-6455

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com