MEDICARE: REMWAY PORT ST LUCIE, LLC

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
2	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1073762431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REMWAY PORT ST LUCIE, LLC

Provider Business Mailing Address
First Line	:	525 NW LAKE WHITNEY PL
Second Line	:	SUITE 102 BLDG P
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-1605
Country	:	US
Telephone Number	:	772-323-2661
Fax Number	:	772-323-2666

Provider Business Practice Location Address
First Line	:	525 NW LAKE WHITNEY PL
Second Line	:	SUITE 102 BLDG P
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-1605
Country	:	US
Telephone Number	:	772-323-2661
Fax Number	:	772-323-2666

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. NICOLE MARTINA MAHABIR-HERRERA
Credential	:
Telephone Number	:	772-323-2661

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/10/2008

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Directions to “REMWAY PORT ST LUCIE, LLC ” Practice Location

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