Healthcare Provider Details

I. General information

NPI: 1497500011
Provider Name (Legal Business Name): PLATINUM HOME & COMMUNITY MOBILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474270 E STATE ROAD 200
FERNANDINA BEACH FL
32034-0805
US

IV. Provider business mailing address

15400 PEARL RD STE 207
STRONGSVILLE OH
44136-6051
US

V. Phone/Fax

Practice location:
  • Phone: 904-261-2111
  • Fax: 904-261-1164
Mailing address:
  • Phone: 440-229-5822
  • Fax: 440-448-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. MARC ANTHONY VASIL
Title or Position: PRESIDENT
Credential: MPT
Phone: 440-229-5822