MEDICARE: COMFORT-N-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	332B00000X	Durable Medical Equipment & Medical Supplies	1079	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R9021	OTHER	FL	BC/BS PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205838158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT-N-MOBILITY, INC.

Provider Business Mailing Address
First Line	:	3082 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3246
Country	:	US
Telephone Number	:	850-934-5217
Fax Number	:	850-934-4771

Provider Business Practice Location Address
First Line	:	3082 GULF BREEZE PKWY
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-3246
Country	:	US
Telephone Number	:	850-934-5217
Fax Number	:	850-934-4771

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	MR. WILLIAM MARTIN BOHATKA
Credential	:
Telephone Number	:	850-934-5217

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	05/05/2010

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