MEDICARE: TEODULO EQUIPMENT @ ORTHOPEDIC SUPPLY, INC

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	332BX2000X	Oxygen Equipment & Supplies (DME)	32 02370	FL

General Provider Information

NPI Number	:	1063493294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEODULO EQUIPMENT @ ORTHOPEDIC SUPPLY, INC

Provider Business Mailing Address
First Line	:	4355 W 16TH AVE
Second Line	:	SUITE 203B
City	:	HIALEAH
State	:	FL
Zip	:	33012-7666
Country	:	US
Telephone Number	:	305-558-5700
Fax Number	:	305-558-5085

Provider Business Practice Location Address
First Line	:	4355 W 16TH AVE
Second Line	:	SUITE 203B
City	:	HIALEAH
State	:	FL
Zip	:	33012-7666
Country	:	US
Telephone Number	:	305-558-5700
Fax Number	:	305-558-5085

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TEODULO C OLMO
Credential	:
Telephone Number	:	305-558-5700

Provider Enumeration Date	:	11/05/2005
Last Update Date	:	08/22/2020

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