MEDICARE: DME SHOPPE - FT MYERS 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	332BC3200X	Customized Equipment (DME)	816	FL

General Provider Information

NPI Number	:	1083616791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DME SHOPPE - FT MYERS INC

Provider Business Mailing Address
First Line	:	4300 FORD STREET EXT
Second Line	:	UNIT 101
City	:	FT MYERS
State	:	FL
Zip	:	33916-9317
Country	:	US
Telephone Number	:	239-936-7070
Fax Number	:	239-936-7367

Provider Business Practice Location Address
First Line	:	4300 FORD STREET EXT
Second Line	:	UNIT 101
City	:	FT MYERS
State	:	FL
Zip	:	33916-9317
Country	:	US
Telephone Number	:	239-936-7070
Fax Number	:	239-936-7367

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CAROL L METHOD
Credential	:
Telephone Number	:	239-936-7070

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/22/2020

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