Healthcare Provider Details

I. General information

NPI: 1922269984
Provider Name (Legal Business Name): DSM MANAGEMENT CORPORATION OF NORTHEAST FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 STATE ROAD 13 NORTH #100
FRUIT COVE FL
32259-3175
US

IV. Provider business mailing address

585 STATE ROAD 13 NORTH #100
FRUIT COVE FL
32259-3175
US

V. Phone/Fax

Practice location:
  • Phone: 904-230-8229
  • Fax: 904-230-8219
Mailing address:
  • Phone: 904-230-8229
  • Fax: 904-230-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPED151
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID RODNEY MARSHALL
Title or Position: CEO PRESIDENT
Credential: CPED
Phone: 904-230-8229