MEDICARE: MID FLORIDA MEDICAL

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

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	:	1780839720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID FLORIDA MEDICAL

Provider Business Mailing Address
First Line	:	2756 ENTERPRISE RD STE B
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8330
Country	:	US
Telephone Number	:	386-774-1390
Fax Number	:	386-774-2346

Provider Business Practice Location Address
First Line	:	2756 B ENTERPRISE ROAD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763
Country	:	US
Telephone Number	:	386-774-1390
Fax Number	:	386-774-2346

Authorized Official
Title or Position	:	OWNER
Name	:	MR. GARY N KNIGHT
Credential	:
Telephone Number	:	800-422-2612

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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Directions to “MID FLORIDA MEDICAL ” Practice Location

Language	Start Address	Practice Location

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