MEDICARE: COMFORT LIFE MEDICAL SUPPLIES, 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	332B00000X	Durable Medical Equipment & Medical Supplies

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6465110001	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1336381854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT LIFE MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	706 NE 26TH AVE
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-2941
Country	:	US
Telephone Number	:	954-564-3381
Fax Number	:	954-564-3386

Provider Business Practice Location Address
First Line	:	4028 N OCEAN BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6420
Country	:	US
Telephone Number	:	954-564-3381
Fax Number	:	954-564-3386

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MRS. MIRRA KERN
Credential	:	MS, MANAGEMENT
Telephone Number	:	954-564-3381

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	04/30/2012

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Directions to “COMFORT LIFE MEDICAL SUPPLIES, LLC ” Practice Location

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