MEDICARE: AMANDA MEDICAL

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	1039	FL
2	332BC3200X	Customized Equipment (DME)
3	332BX2000X	Oxygen Equipment & Supplies (DME)	1039	FL
4	332BC3200X	Customized Equipment (DME)	1039	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427053321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANDA MEDICAL

Provider Business Mailing Address
First Line	:	3720 TAMPA RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3621
Country	:	US
Telephone Number	:	727-535-6100
Fax Number	:	727-535-6466

Provider Business Practice Location Address
First Line	:	3720 TAMPA RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3621
Country	:	US
Telephone Number	:	727-535-6100
Fax Number	:	727-535-6466

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RUBEN EUGENE JONES
Credential	:	M.S., ATP
Telephone Number	:	727-535-6100

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/28/2022

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Directions to “AMANDA MEDICAL ” Practice Location

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