MEDICARE: M. DAVIS MANAGEMENT, 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	957	FL
2	332BX2000X	Oxygen Equipment & Supplies (DME)	957	FL

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
2	R8641	OTHER	FL	BC/BS PROVIDER NUMBER

General Provider Information

NPI Number	:	1689603300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. DAVIS MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	3325 BARTLETT BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-6428
Country	:	US
Telephone Number	:	407-206-0040
Fax Number	:	407-206-0010

Provider Business Practice Location Address
First Line	:	4502 35TH ST
Second Line	:	STE 700
City	:	ORLANDO
State	:	FL
Zip	:	32811-6500
Country	:	US
Telephone Number	:	407-539-0303
Fax Number	:	407-539-0304

Authorized Official
Title or Position	:	CEO
Name	:	STEPHEN P GRIGGS
Credential	:
Telephone Number	:	407-206-0040

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	02/14/2011

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