MEDICARE: MR. GEORGE COLONEY IV

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		FL

General Provider Information

NPI Number	:	1861044661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE COLONEY IV

Provider Business Mailing Address
First Line	:	313 NE 2ND ST APT 1005
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-1251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 E SUNRISE BLVD STE 201
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2363
Country	:	US
Telephone Number	:	954-398-4474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	08/01/2022

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