MEDICARE: QUALIMED RESPIRATORY AND MOBILITY, 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)	1312560	FL

General Provider Information

NPI Number	:	1194737841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALIMED RESPIRATORY AND MOBILITY, INC.

Provider Business Mailing Address
First Line	:	704 3RD ST SW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-3418
Country	:	US
Telephone Number	:	863-293-3066
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4655
Country	:	US
Telephone Number	:	863-683-4663
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN T WILLIS
Credential	:
Telephone Number	:	863-293-3066

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	03/31/2008

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