Healthcare Provider Details

I. General information

NPI: 1184225047
Provider Name (Legal Business Name): HALO FLORIDA DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 PONDELLA RD STE 4
NORTH FORT MYERS FL
33903-5730
US

IV. Provider business mailing address

710 PONDELLA RD STE 4
NORTH FORT MYERS FL
33903-5730
US

V. Phone/Fax

Practice location:
  • Phone: 239-236-7750
  • Fax:
Mailing address:
  • Phone: 239-236-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAID AWWAD
Title or Position: PRESIDENT & CEO
Credential:
Phone: 239-236-7750