Provider Demographics
NPI:1033575733
Name:SOUTHWEST FLORIDA HOME MEDICAL EQUIPMENT SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHWEST FLORIDA HOME MEDICAL EQUIPMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-280-6131
Mailing Address - Street 1:11000 METRO PKWY STE 23
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1244
Mailing Address - Country:US
Mailing Address - Phone:239-689-6728
Mailing Address - Fax:238-689-6730
Practice Address - Street 1:11000 METRO PKWY STE 23
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1244
Practice Address - Country:US
Practice Address - Phone:239-689-6728
Practice Address - Fax:238-689-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7569340001OtherMEDICARE PTAN
FL018477200Medicaid