Basic Information
| Provider Information | |||||||||
| NPI: | 1265819619 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FLORIDA HOME MEDICAL SUPPLY, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLONIAL MEDICAL SUPPLIES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 614 E ALTAMONTE DR | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078496455 | ||||||||
| FaxNumber: | 4078496458 | ||||||||
| Practice Location | |||||||||
| Address1: | 985 HARLEY STRICKLAND BLVD STE 100E | ||||||||
| Address2: | |||||||||
| City: | ORANGE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327637980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078496455 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2015 | ||||||||
| LastUpdateDate: | 06/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | BRUINSMA | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4078496455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.