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General NPI Number Information
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NPI Number | 1194723049
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Entity Type | Organization
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Legal Business Name | WILLIAM MAC VANDERPOOL JR
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 2860 LAKE ALFRED RD
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City | WINTER HAVEN
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State | FL
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Zip | 33881-1435
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Country | US
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Telephone | 863-595-1440
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 950
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City | AUBURNDALE
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State | FL
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Zip | 33823-0950
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Country | US
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Telephone | 863-595-1440
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Fax | 863-595-1441
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Authorized Official
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Title or Position | OWNER
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Name | MR. WILLIAM MAC VANDERPOOL JR.
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Credential |
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Telephone | 863-595-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 1312052
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License Number State | FL
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