Provider Demographics
NPI:1104852995
Name:MED-SOURCE OF CENTRAL FLORIDA, INC
Entity Type:Organization
Organization Name:MED-SOURCE OF CENTRAL FLORIDA, INC
Other - Org Name:
Other - Org Type:
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:386-774-8900
Mailing Address - Street 1:1495 S VOLUSIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-7047
Mailing Address - Country:US
Mailing Address - Phone:386-774-8900
Mailing Address - Fax:386-774-2040
Practice Address - Street 1:1495 S VOLUSIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7047
Practice Address - Country:US
Practice Address - Phone:386-774-8900
Practice Address - Fax:386-774-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2001332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4717420001Medicare NSC