Healthcare Provider Details

I. General information

NPI: 1487081840
Provider Name (Legal Business Name): ALBROOK MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5889 S WILLIAMSON BLVD SUITE 1405
PORT ORANGE FL
32128-7134
US

IV. Provider business mailing address

5889 S WILLIAMSON BLVD SUITE 1405
PORT ORANGE FL
32128-7134
US

V. Phone/Fax

Practice location:
  • Phone: 386-761-0911
  • Fax: 386-761-0915
Mailing address:
  • Phone: 386-761-0911
  • Fax: 386-761-0915

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 Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN KEITH PADGETT
Title or Position: OWNER, PRESIDENT
Credential:
Phone: 386-451-6089