Healthcare Provider Details

I. General information

NPI: 1043838485
Provider Name (Legal Business Name): ORIGIN MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 DATURA ST STE 1309
WEST PALM BEACH FL
33401-5641
US

IV. Provider business mailing address

224 DATURA ST STE 1309
WEST PALM BEACH FL
33401-5641
US

V. Phone/Fax

Practice location:
  • Phone: 305-619-5378
  • Fax:
Mailing address:
  • Phone: 727-267-8910
  • 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: CHRISTOPHER SPELLMAN
Title or Position: OWNER
Credential:
Phone: 866-953-5386