MEDICARE: HOME DIAGNOSTICS ON WHEELS

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1295325488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME DIAGNOSTICS ON WHEELS

Provider Business Mailing Address
First Line	:	1030 SUMMIT PLACE CIRCLE, C
Second Line	:	C
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415
Country	:	US
Telephone Number	:	561-254-3658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 SUMMIT PLACE CIR # 05082017
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-4700
Country	:	US
Telephone Number	:	561-254-3658
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	FRANCENA HICKS
Credential	:
Telephone Number	:	561-254-3658

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	01/21/2021

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