MEDICARE: MOBILITY EXPRESS OF FRUITLAND PARK 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	1888	FL

General Provider Information

NPI Number	:	1588664619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILITY EXPRESS OF FRUITLAND PARK INC

Provider Business Mailing Address
First Line	:	PO BOX 5370
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32247-5370
Country	:	US
Telephone Number	:	904-739-1309
Fax Number	:	904-739-1310

Provider Business Practice Location Address
First Line	:	3327 US HIGHWAY 441/27
Second Line	:
City	:	FRUITLAND PARK
State	:	FL
Zip	:	34731-4478
Country	:	US
Telephone Number	:	352-365-2055
Fax Number	:	352-330-2748

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFFREY S BOGAN
Credential	:
Telephone Number	:	904-962-2123

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	04/19/2011

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