Healthcare Provider Details

I. General information

NPI: 1891780011
Provider Name (Legal Business Name): CAMELOT HEALTHCARE MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 JOHN SIMS PKWY EAST
NICEVILLE FL
32578
US

IV. Provider business mailing address

4656 SW 74 AVE
MIAMI FL
33155
US

V. Phone/Fax

Practice location:
  • Phone: 850-729-1166
  • Fax: 850-678-9245
Mailing address:
  • Phone: 305-267-2278
  • Fax: 305-267-2279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHME906
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberHME906
License Number StateFL

VIII. Authorized Official

Name: MR. ANGEL ARCIERO
Title or Position: PRESIDENT
Credential:
Phone: 305-267-2278