Healthcare Provider Details

I. General information

NPI: 1083743694
Provider Name (Legal Business Name): LAZBOY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 SW 34TH ST
GAINESVILLE FL
32608-2552
US

IV. Provider business mailing address

3606 SW 34TH ST
GAINESVILLE FL
32608-2552
US

V. Phone/Fax

Practice location:
  • Phone: 352-375-6727
  • Fax: 352-375-6998
Mailing address:
  • Phone: 352-375-6727
  • Fax: 352-375-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number11-8013402238-3
License Number StateFL

VIII. Authorized Official

Name: MR. GARY JARBOE
Title or Position: OWNER
Credential:
Phone: 352-375-6727