MEDICARE: COUNTRY SOUTH 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	943257	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	:	1477556389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTRY SOUTH INC

Provider Business Mailing Address
First Line	:	PO BOX 110189
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34108-0104
Country	:	US
Telephone Number	:	239-514-1156
Fax Number	:	239-514-1159

Provider Business Practice Location Address
First Line	:	5567 TAYLOR RD
Second Line	:	STE 8
City	:	NAPLES
State	:	FL
Zip	:	34109-1880
Country	:	US
Telephone Number	:	239-514-1156
Fax Number	:	239-514-1159

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATHERINE ELIZABETH FISCINA
Credential	:
Telephone Number	:	239-514-1156

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/15/2009

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Directions to “COUNTRY SOUTH INC ” Practice Location

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