Provider Demographics
NPI:1245292960
Name:DURAMED MOBILITY OF FLA, INC
Entity type:Organization
Organization Name:DURAMED MOBILITY OF FLA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARLYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-296-9339
Mailing Address - Street 1:8110 CYPRESS PLAZA DRIVE, SUITE 308
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4469
Mailing Address - Country:US
Mailing Address - Phone:904-296-9339
Mailing Address - Fax:904-296-9338
Practice Address - Street 1:8110 CYPRESS PLAZA DRIVE, SUITE 308
Practice Address - Street 2:
Practice Address - City:JAX
Practice Address - State:FL
Practice Address - Zip Code:32256-4469
Practice Address - Country:US
Practice Address - Phone:904-296-9339
Practice Address - Fax:904-296-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1420332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000308200OtherBRAIN & SPINAL MEDICAID WAIVER PROGRAM
FL0008228-00Medicaid
FL1420OtherFL AHCA HME LICENSE
FL1420OtherFL AHCA HME LICENSE