Provider Demographics
NPI:1023189321
Name:E-MED SOURCE OF FLORIDA, INC.
Entity Type:Organization
Organization Name:E-MED SOURCE OF FLORIDA, INC.
Other - Org Name:ANGELS CARE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:EYER
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPA
Authorized Official - Phone:813-886-2023
Mailing Address - Street 1:4801 GEORGE RD
Mailing Address - Street 2:STE 190
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6265
Mailing Address - Country:US
Mailing Address - Phone:813-886-2023
Mailing Address - Fax:813-886-2096
Practice Address - Street 1:4801 GEORGE RD
Practice Address - Street 2:STE 190
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6265
Practice Address - Country:US
Practice Address - Phone:813-886-2023
Practice Address - Fax:813-886-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991850251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108063Medicare ID - Type UnspecifiedPROVIDER NUMBER