Provider Demographics
NPI:1053382317
Name:FAMILY HOME MEDICAL EQUIPMENT & SUPPLIES, LLC
Entity type:Organization
Organization Name:FAMILY HOME MEDICAL EQUIPMENT & SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 1:1825 TAMIAMI TRL
Practice Address - Street 2:SUITE E1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1077
Practice Address - Country:US
Practice Address - Phone:941-624-0127
Practice Address - Fax:941-624-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1095332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1095OtherFLORIDA AGENCY FOR HEALTH
FL1095OtherFLORIDA AGENCY FOR HEALTH