Basic Information
| Provider Information | |||||||||
| NPI: | 1629072640 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LAMAR, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOME OXYGEN MEDICAL EQUIPMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3325 BARTLETT BLVD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328116428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072060040 | ||||||||
| FaxNumber: | 4072060010 | ||||||||
| Practice Location | |||||||||
| Address1: | 13881 PLANTATION RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392753326 | ||||||||
| FaxNumber: | 2392754899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2005 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GRIGGS | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4072060040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AEROCARE HOLDINGS LLC | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 1312066 | FL | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BX2000X | 32103723 | FL | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | R9544 | 01 | FL | BCBS | OTHER | 026615900 | 05 | FL | MEDICAID |