MEDICARE: MED-SOURCE OF CENTRAL FLORIDA, 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)	2001	FL

General Provider Information

NPI Number	:	1104852995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-SOURCE OF CENTRAL FLORIDA, INC

Provider Business Mailing Address
First Line	:	1495 S VOLUSIA AVE
Second Line	:	SUITE 101
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7047
Country	:	US
Telephone Number	:	386-774-8900
Fax Number	:	386-774-2040

Provider Business Practice Location Address
First Line	:	1495 S VOLUSIA AVE
Second Line	:	SUITE 101
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7047
Country	:	US
Telephone Number	:	386-774-8900
Fax Number	:	386-774-2040

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MRS. LAURIE BOWLING
Credential	:
Telephone Number	:	386-774-8900

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	08/27/2008

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