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General NPI Number Information
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NPI Number | 1104852995
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Entity Type | Organization
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Legal Business Name | MED-SOURCE OF CENTRAL FLORIDA, INC
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 1495 S VOLUSIA AVE SUITE 101
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City | ORANGE CITY
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State | FL
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Zip | 32763-7047
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Country | US
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Telephone | 386-774-8900
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Fax | 386-774-2040
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Provider Business Mailing Address
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Address Line | 1495 S VOLUSIA AVE SUITE 101
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City | ORANGE CITY
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State | FL
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Zip | 32763-7047
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Country | US
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Telephone | 386-774-8900
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Fax | 386-774-2040
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. LAURIE BOWLING
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Credential |
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Telephone | 386-774-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 2001
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License Number State | FL
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