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NPI Code Detail

MEDICARE: A&L GOODSOURCE MEDICAL PRODUCTS,LLC

MEDICARE: A&L GOODSOURCE MEDICAL PRODUCTS,LLC
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
1332B00000XDurable Medical Equipment & Medical Supplies1313549FL

General Provider Information

NPI Number : 1417102344
Entity Type Code : Organization
Provider Name (Legal Business Name) : A&L GOODSOURCE MEDICAL PRODUCTS,LLC
Provider Business Mailing Address
First Line : 2290 N RONALD REAGAN BLVD STE 124
Second Line :
City : LONGWOOD
State : FL
Zip : 32750-3534
Country : US
Telephone Number : 321-972-6906
Fax Number : 321-972-6907
Provider Business Practice Location Address
First Line : 2290 N RONALD REAGAN BLVD STE 124
Second Line :
City : LONGWOOD
State : FL
Zip : 32750-3534
Country : US
Telephone Number : 321-972-6906
Fax Number : 321-972-6907
Authorized Official
Title or Position : GENERAL MANAGER
Name : MR. ANGEL R BONILLA
Credential : HME
Telephone Number : 321-972-6906
Provider Enumeration Date : 11/19/2008
Last Update Date : 08/10/2009

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Directions to “A&L GOODSOURCE MEDICAL PRODUCTS,LLC ” Practice Location

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