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General NPI Number Information
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NPI Number | 1104907922
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Entity Type | Organization
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Legal Business Name | SUFFOLK HOME MEDICAL
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 10/02/2008
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Provider Practice Location Address
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Address Line | 815 W CONSTANCE RD
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City | SUFFOLK
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State | VA
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Zip | 23434-5649
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Country | US
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Telephone | 757-539-2772
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Fax | 757-539-5037
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Provider Business Mailing Address
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Address Line | 47 GRAND PALMS BLVD
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City | ENGLEWOOD
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State | FL
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Zip | 34223-1808
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Country | US
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Telephone | 941-473-1187
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Fax | 941-473-1187
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS INMAN
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Credential |
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Telephone | 941-473-1187
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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 | 001878
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License Number State | VA
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