MEDICARE: OSTOMY INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0500138	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SG027558	OTHER	FL	VISTA
2	M1171	OTHER	FL	BCBS HEALTH OPTIONS

General Provider Information

NPI Number	:	1023011756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSTOMY INCORPORATED

Provider Business Mailing Address
First Line	:	5420 W ATLANTIC BLVD
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-5209
Country	:	US
Telephone Number	:	954-975-8004
Fax Number	:	954-973-3141

Provider Business Practice Location Address
First Line	:	5420 W ATLANTIC BLVD
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-5209
Country	:	US
Telephone Number	:	954-975-8004
Fax Number	:	954-973-3141

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. JULIE EBEL GAREAU
Credential	:
Telephone Number	:	954-975-8004

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/20/2008

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Directions to “OSTOMY INCORPORATED ” Practice Location

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