Provider Demographics
NPI:1770604258
Name:SOMTO MEDICAL SUPPLY AND HOME HEALTH CARE
Entity type:Organization
Organization Name:SOMTO MEDICAL SUPPLY AND HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESSOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IMELDA
Authorized Official - Middle Name:AZUOMA
Authorized Official - Last Name:NWOGA
Authorized Official - Suffix:
Authorized Official - Credentials:042452
Authorized Official - Phone:904-347-4357
Mailing Address - Street 1:1205 ELLINGTON CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1832
Mailing Address - Country:US
Mailing Address - Phone:904-347-4357
Mailing Address - Fax:904-823-9541
Practice Address - Street 1:2825 LEWIS SPEEDWAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-8668
Practice Address - Country:US
Practice Address - Phone:904-347-4357
Practice Address - Fax:904-823-9541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35707332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies