=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417217951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABC HOME MEDICAL SUPPLY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2012
-----------------------------------------------------
Last Update Date | 12/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1660 SW SAINT LUCIE WEST BLVD STE 200
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34986-1965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-232-7180
-----------------------------------------------------
Fax | 722-326-2977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 674553
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48267-4553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-232-7180
-----------------------------------------------------
Fax | 772-232-6297
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND DIRECTOR
-----------------------------------------------------
Name | EMILY M VESTAL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-897-8588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------