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General NPI Number Information
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NPI Number | 1124635800
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Entity Type | Organization
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Legal Business Name | MD HEALTH SOURCE INC
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 370 CAMINO GARDENS BLVD STE 210B
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City | BOCA RATON
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State | FL
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Zip | 33432-5818
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Country | US
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Telephone | 800-793-3122
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Fax |
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Provider Business Mailing Address
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Address Line | 370 CAMINO GARDENS BLVD STE 210B
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City | BOCA RATON
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State | FL
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Zip | 33432-5818
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Country | US
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Telephone | 800-793-3122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL JON DUBOIS
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Credential |
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Telephone | 800-793-3122
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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 |
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License Number State |
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