MEDICARE: HOME AGAIN OXYGEN AND MOBILITY PRODUCTS

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	1651	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
2	R9401	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1114920410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME AGAIN OXYGEN AND MOBILITY PRODUCTS

Provider Business Mailing Address
First Line	:	25270 BERNWOOD DR
Second Line	:	UNIT 5
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-7897
Country	:	US
Telephone Number	:	239-390-1077
Fax Number	:	239-390-0444

Provider Business Practice Location Address
First Line	:	25270 BERNWOOD DR
Second Line	:	UNIT 5
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-7897
Country	:	US
Telephone Number	:	239-390-1077
Fax Number	:	239-390-0444

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICHARD G HEADLEY
Credential	:
Telephone Number	:	239-390-1077

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/07/2012

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