Provider Demographics
NPI:1265819619
Name:FLORIDA HOME MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:FLORIDA HOME MEDICAL SUPPLY, INC.
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:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRUINSMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-849-6455
Mailing Address - Street 1:614 E ALTAMONTE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4803
Mailing Address - Country:US
Mailing Address - Phone:407-849-6455
Mailing Address - Fax:407-849-6458
Practice Address - Street 1:985 HARLEY STRICKLAND BLVD STE 100E
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7980
Practice Address - Country:US
Practice Address - Phone:407-849-6455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies