MEDICARE: OLIVE MEDICAL SOLUTIONS, INC.

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

General Provider Information

NPI Number	:	1376011700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE MEDICAL SOLUTIONS, INC.

Provider Business Mailing Address
First Line	:	1465 S FORT HARRISON AVE STE 208
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-2504
Country	:	US
Telephone Number	:	727-221-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1465 S FORT HARRISON AVE STE 208
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-2504
Country	:	US
Telephone Number	:	727-221-9711
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLY WOLFE
Credential	:
Telephone Number	:	727-560-2353

Provider Enumeration Date	:	11/03/2018
Last Update Date	:	11/03/2018

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Directions to “OLIVE MEDICAL SOLUTIONS, INC. ” Practice Location

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