MEDICARE: CHOICE MEDICAL 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1255087904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOICE MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	2180 W FIRST ST STE 500
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3217
Country	:	US
Telephone Number	:	239-362-3218
Fax Number	:	239-362-3470

Provider Business Practice Location Address
First Line	:	2180 W FIRST ST STE 500
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3217
Country	:	US
Telephone Number	:	239-362-3218
Fax Number	:	239-362-3470

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MITCHEL A SALADRIGA MILIAN
Credential	:
Telephone Number	:	239-362-3218

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	03/14/2022

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