Provider Demographics
NPI:1669873469
Name:LILY MEDICAL, LLC
Entity type:Organization
Organization Name:LILY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:537-893-7111
Mailing Address - Street 1:PO BOX 743122
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3122
Mailing Address - Country:US
Mailing Address - Phone:573-893-7111
Mailing Address - Fax:573-415-0413
Practice Address - Street 1:7680 UNIVERSAL BLVD
Practice Address - Street 2:STE 575
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8900
Practice Address - Country:US
Practice Address - Phone:573-893-7111
Practice Address - Fax:573-415-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL14000135305332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies