Provider Demographics
NPI:1376011700
Name:OLIVE MEDICAL SOLUTIONS, INC.
Entity Type:Organization
Organization Name:OLIVE MEDICAL SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-560-2353
Mailing Address - Street 1:1465 S FORT HARRISON AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2504
Mailing Address - Country:US
Mailing Address - Phone:727-221-9711
Mailing Address - Fax:
Practice Address - Street 1:1465 S FORT HARRISON AVE STE 208
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2504
Practice Address - Country:US
Practice Address - Phone:727-221-9711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-03
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies