Healthcare Provider Details

I. General information

NPI: 1023011756
Provider Name (Legal Business Name): OSTOMY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 W ATLANTIC BLVD
MARGATE FL
33063-5209
US

IV. Provider business mailing address

5420 W ATLANTIC BLVD
MARGATE FL
33063-5209
US

V. Phone/Fax

Practice location:
  • Phone: 954-975-8004
  • Fax: 954-973-3141
Mailing address:
  • Phone: 954-975-8004
  • Fax: 954-973-3141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0500138
License Number StateFL

VIII. Authorized Official

Name: MRS. JULIE EBEL GAREAU
Title or Position: VICE PRESIDENT
Credential:
Phone: 954-975-8004