MEDICARE: DSM MANAGEMENT CORPORATION OF NORTHEAST FLORIDA 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	335E00000X	Prosthetic/Orthotic Supplier	PED151	FL

General Provider Information

NPI Number	:	1922269984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DSM MANAGEMENT CORPORATION OF NORTHEAST FLORIDA INC

Provider Business Mailing Address
First Line	:	585 STATE ROAD 13 NORTH
Second Line	:	#100
City	:	FRUIT COVE
State	:	FL
Zip	:	32259-3175
Country	:	US
Telephone Number	:	904-230-8229
Fax Number	:	904-230-8219

Provider Business Practice Location Address
First Line	:	585 STATE ROAD 13 NORTH
Second Line	:	#100
City	:	FRUIT COVE
State	:	FL
Zip	:	32259-3175
Country	:	US
Telephone Number	:	904-230-8229
Fax Number	:	904-230-8219

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	MR. DAVID RODNEY MARSHALL
Credential	:	CPED
Telephone Number	:	904-230-8229

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	05/16/2011

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