MEDICARE: DURA-MED SOUTHEAST, 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	:	1336371087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DURA-MED SOUTHEAST, INC.

Provider Business Mailing Address
First Line	:	5272 COMMERCE ST
Second Line	:	P.O. BOX 190
City	:	JAY
State	:	FL
Zip	:	32565-1178
Country	:	US
Telephone Number	:	850-675-2448
Fax Number	:

Provider Business Practice Location Address
First Line	:	5941 BERRYHILL RD
Second Line	:
City	:	MILTON
State	:	FL
Zip	:	32570-4043
Country	:	US
Telephone Number	:	850-623-2988
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JACK R. FLOYD
Credential	:
Telephone Number	:	850-675-2448

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	08/13/2009

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