Healthcare Provider Details

I. General information

NPI: 1548262850
Provider Name (Legal Business Name): PROFESSIONAL HEALTH CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 RACETRACK RD NW STE C
FORT WALTON BEACH FL
32547-1554
US

IV. Provider business mailing address

350 RACETRACK RD NW STE C
FORT WALTON BEACH FL
32547-1554
US

V. Phone/Fax

Practice location:
  • Phone: 850-279-1200
  • Fax: 850-250-5508
Mailing address:
  • Phone: 850-279-1200
  • Fax: 850-250-5508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6714
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number6714
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number900048
License Number StateAL

VIII. Authorized Official

Name: LISA J WELLS
Title or Position: SVP
Credential:
Phone: 205-221-8258