MEDICARE: MEDICAL HOMECARE 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)	19	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093701146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL HOMECARE SUPPLY, INC.

Provider Business Mailing Address
First Line	:	4664 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3452
Country	:	US
Telephone Number	:	561-965-2785
Fax Number	:	561-965-2785

Provider Business Practice Location Address
First Line	:	4664 LAKE WORTH RD
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33463-3452
Country	:	US
Telephone Number	:	561-965-2785
Fax Number	:	561-965-2785

Authorized Official
Title or Position	:	V.P. MANAGER
Name	:	MR. MAURICE J LECKER
Credential	:
Telephone Number	:	561-965-2785

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	08/22/2020

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