MEDICARE: COLTOM 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	OE849	FL

General Provider Information

NPI Number	:	1992856744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLTOM INC.

Provider Business Mailing Address
First Line	:	5443 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-4563
Country	:	US
Telephone Number	:	352-686-0553
Fax Number	:	353-686-0428

Provider Business Practice Location Address
First Line	:	5443 SPRING HILL DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-4563
Country	:	US
Telephone Number	:	352-686-0553
Fax Number	:	353-686-0428

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. COLLEEN FERRIS
Credential	:	D.O.
Telephone Number	:	352-686-0553

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/22/2020

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