Provider Demographics
NPI:1114125143
Name:FLORIDA HOME MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:FLORIDA HOME MEDICAL SUPPLY LLC
Other - Org Name:COLONIAL MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-206-0040
Mailing Address - Street 1:220 W GERMANTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1437
Mailing Address - Country:US
Mailing Address - Phone:610-630-6357
Mailing Address - Fax:
Practice Address - Street 1:1113 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4405
Practice Address - Country:US
Practice Address - Phone:407-849-6455
Practice Address - Fax:407-849-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 335E00000X
FL1313277332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL327174OtherMEDICAL OXYGEN RETAIL SUPPLIER
FL001517300Medicaid
FL1313277OtherHOME MEDICAL EQUIPMENT SUPPLIER
ID18070OtherDURABLE MEDICAL EQUIPMENT OUTLET REGISTRATION
PA6000008043OtherDRUG, DEVICE & COSMETIC REGISTRATION LICENSE
KS16-12156OtherDURABLE MEDICAL EQUIPMENT CERTIFICATE
AZ225012OtherWHOLESALER FULL SERVICE
UT8209591-1714OtherCLASS E PHARMACY LICENSE
FL1313277OtherHOME MEDICAL EQUIPMENT SUPPLIER
MI5306003688OtherMANUFACTURER AND WHOLSALER LICENSE
ORNPC-0003757OtherMEDICAL DEVICE AND EQUIPMENT LICENSE AND GAS OUTLET
OKOK-1897-FLOtherGERMICIDAL TREATMENT PERMIT
FL001517300Medicaid
MS10546/11.1OtherMEDICAL EQUIPMENT SUPPLIER PERMIT
FL32-6475OtherOXYGEN RETAIL SUPPLIER
CA57410OtherHOME MEDICAL DEVICE RETAILER LICENSE
IN69000964AOtherHOME MEDICAL EQUIPMENT SERVICE PROVIDER
AZC000850OtherMEDICAL GAS SUPPLIER
OHHMER 23007OtherHOME MEDICAL SERVICES PROVIDER LICENSE
NC01924OtherDEVICE AND MEDICAL EQUIPMENT DISPENSING PERMIT
VA0206009697OtherMEDICAL EQUIPMENT SUPPLIER PERMIT
AR065787OtherSUPPLIER OF MEDICAL EQUIPMENT, LEGEND DEVICES, MEDICAL GAS PERMIT
NH8154OtherLIMITED RETAIL DRUG DISTRIBUTORS LICENSE
AZC000850OtherMEDICAL GAS SUPPLIER