MEDICARE: HODGES CONVALESCENT AIDS, 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	150591	FL

General Provider Information

NPI Number	:	1285631804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HODGES CONVALESCENT AIDS, INC

Provider Business Mailing Address
First Line	:	405 S 7TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-8322
Country	:	US
Telephone Number	:	772-464-4362
Fax Number	:	770-464-4382

Provider Business Practice Location Address
First Line	:	405 S 7TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-8322
Country	:	US
Telephone Number	:	772-464-4362
Fax Number	:	770-464-4382

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GERALD T CAPAK
Credential	:	R.PH
Telephone Number	:	772-567-5297

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	08/22/2020

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