MEDICARE: MY DME DOC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BC3200X	Customized Equipment (DME)
3	335E00000X	Prosthetic/Orthotic Supplier
4	332BX2000X	Oxygen Equipment & Supplies (DME)
5	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619353836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY DME DOC LLC

Provider Business Mailing Address
First Line	:	PO BOX 27968
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0968
Country	:	US
Telephone Number	:	570-966-8030
Fax Number	:	800-868-3117

Provider Business Practice Location Address
First Line	:	6405 SW 38TH ST BLDG 100
Second Line	:	SUITES 101-104
City	:	OCALA
State	:	FL
Zip	:	34474-6539
Country	:	US
Telephone Number	:	866-726-9363
Fax Number	:	800-356-0636

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MS. ROBIN L MENCHEN
Credential	:
Telephone Number	:	407-822-4600

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	02/17/2026

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Directions to “MY DME DOC LLC ” Practice Location

Language	Start Address	Practice Location

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