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General NPI Number Information
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NPI Number | 1093221798
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Entity Type | Organization
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Legal Business Name | QUALITY OF LIFE DME LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1501 5TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33705-2008
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Country | US
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Telephone | 727-485-8780
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Fax | 855-816-9860
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Provider Business Mailing Address
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Address Line | 1501 5TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33705-2008
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Country | US
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Telephone | 727-485-8780
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Fax | 855-816-9860
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICKY P LOCKETT
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Credential | DO
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Telephone | 727-896-8686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | OS6109
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License Number State | FL
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