Healthcare Provider Details

I. General information

NPI: 1467638700
Provider Name (Legal Business Name): PONCE HOME MEDICAL EQUIPMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 STATE ROAD 207 SUITE 108
SAINT AUGUSTINE FL
32084-5938
US

IV. Provider business mailing address

PO BOX 3123
SAINT AUGUSTINE FL
32085-3123
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-0700
  • Fax: 904-826-0800
Mailing address:
  • Phone: 904-824-4990
  • Fax: 904-824-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1313412
License Number StateFL

VIII. Authorized Official

Name: BETTY PONCE
Title or Position: CEO OWNER
Credential: MS
Phone: 904-826-0700