MEDICARE: HALO FLORIDA DME LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1184225047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALO FLORIDA DME LLC

Provider Business Mailing Address
First Line	:	710 PONDELLA RD STE 4
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-5730
Country	:	US
Telephone Number	:	239-236-7750
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 PONDELLA RD STE 4
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-5730
Country	:	US
Telephone Number	:	239-236-7750
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	SAID AWWAD
Credential	:
Telephone Number	:	239-236-7750

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	02/22/2022

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