Basic Information
| Provider Information | |||||||||
| NPI: | 1083616791 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DME SHOPPE - FT MYERS INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | DME SHOPPE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 FORD STREET EXT | ||||||||
| Address2: | UNIT 101 | ||||||||
| City: | FT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339169317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399367070 | ||||||||
| FaxNumber: | 2399367367 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 FORD STREET EXT | ||||||||
| Address2: | UNIT 101 | ||||||||
| City: | FT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339169317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399367070 | ||||||||
| FaxNumber: | 2399367367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | METHOD | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2399367070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | 816 | FL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.