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General NPI Number Information
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NPI Number | 1760560809
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Entity Type | Organization
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Legal Business Name | IC MED SUPPLY INC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 5730 BOWDEN RD STE 103
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6104
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Country | US
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Telephone | 904-733-3333
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Fax | 800-732-0860
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Provider Business Mailing Address
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Address Line | 5730 BOWDEN RD STE 103
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City | JACKSONVILLE
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State | FL
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Zip | 32216-6104
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Country | US
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Telephone | 904-733-3333
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Fax | 800-732-0860
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS GAMEZ
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Credential |
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Telephone | 904-733-3333
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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 |
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License Number State |
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