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General NPI Number Information
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NPI Number | 1770604258
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Entity Type | Organization
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Legal Business Name | SOMTO MEDICAL SUPPLY AND HOME HEALTH CARE
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2825 LEWIS SPEEDWAY
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-8668
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Country | US
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Telephone | 904-347-4357
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Fax | 904-823-9541
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Provider Business Mailing Address
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Address Line | 1205 ELLINGTON CT
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-1832
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Country | US
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Telephone | 904-347-4357
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Fax | 904-823-9541
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Authorized Official
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Title or Position | BUSINESSOWNER
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Name | DR. IMELDA AZUOMA NWOGA
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Credential | 042452
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Telephone | 904-347-4357
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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 | 35707
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License Number State | FL
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