Healthcare Provider Details

I. General information

NPI: 1083635338
Provider Name (Legal Business Name): SOUTHWEST MEDICAL EQUIPMENT & SUPPLIES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 DEL PRADO BLVD SUITE 3
CAPE CORAL FL
33990
US

IV. Provider business mailing address

819 DEL PRADO BLVD SUITE 3
CAPE CORAL FL
33990
US

V. Phone/Fax

Practice location:
  • Phone: 239-574-6334
  • Fax: 239-574-8081
Mailing address:
  • Phone: 239-574-6334
  • Fax: 239-574-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number427
License Number StateFL

VIII. Authorized Official

Name: MS. BONNIE MARGARET KELLER
Title or Position: PRESIDENT
Credential:
Phone: 239-574-6334