Provider Demographics
NPI:1427377944
Name:FAMILY HOME MEDICAL EQUIPMENT & SUPPLIES, LLC
Entity Type:Organization
Organization Name:FAMILY HOME MEDICAL EQUIPMENT & SUPPLIES, LLC
Other - Org Name:FAMILY HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-624-0127
Mailing Address - Street 1:1825 TAMIAMI TRL
Mailing Address - Street 2:SUITE E1
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1077
Mailing Address - Country:US
Mailing Address - Phone:941-624-0127
Mailing Address - Fax:941-624-6098
Practice Address - Street 1:303 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2631
Practice Address - Country:US
Practice Address - Phone:229-269-4585
Practice Address - Fax:229-269-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3931660004Medicare NSC