Provider Demographics
NPI:1083616791
Name:DME SHOPPE - FT MYERS INC
Entity Type:Organization
Organization Name:DME SHOPPE - FT MYERS INC
Other - Org Name:DME SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:METHOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-936-7070
Mailing Address - Street 1:4300 FORD STREET EXT
Mailing Address - Street 2:UNIT 101
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9317
Mailing Address - Country:US
Mailing Address - Phone:239-936-7070
Mailing Address - Fax:239-936-7367
Practice Address - Street 1:4300 FORD STREET EXT
Practice Address - Street 2:UNIT 101
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-9317
Practice Address - Country:US
Practice Address - Phone:239-936-7070
Practice Address - Fax:239-936-7367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL816332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0183450001Medicare ID - Type Unspecified