Provider Demographics
NPI:1063669448
Name:MED-SOURCE OF CENTRAL FLORIDA, INC.
Entity Type:Organization
Organization Name:MED-SOURCE OF CENTRAL FLORIDA, INC.
Other - Org Name:MED-SOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-890-0928
Mailing Address - Street 1:810 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-8520
Mailing Address - Country:US
Mailing Address - Phone:615-890-0928
Mailing Address - Fax:615-890-4806
Practice Address - Street 1:810 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-8520
Practice Address - Country:US
Practice Address - Phone:615-890-0928
Practice Address - Fax:615-890-4806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MED-SOURCE OF CENTRAL FLORIDA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-27
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN951332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4717420002Medicare NSC