MEDICARE: TLC OXYGEN & MEDICAL SUPPLIES, 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	1907	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R9406	OTHER	FL	BLUE SHIELD PROVIDER #

General Provider Information

NPI Number	:	1629028808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC OXYGEN & MEDICAL SUPPLIES, INC.

Provider Business Mailing Address
First Line	:	2003 W CYPRESS CREEK RD STE 104
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1834
Country	:	US
Telephone Number	:	844-402-2768
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 W CYPRESS CREEK RD STE 104
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1834
Country	:	US
Telephone Number	:	844-402-2768
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES ALEXANDRE
Credential	:
Telephone Number	:	954-608-1665

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	02/12/2019

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