Organization Name: | WILLIAM MAC VANDERPOOL JR |
NPI Number: | 1194723049 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM MAC VANDERPOOL (OWNER) |
Mailing Address: | 610 Magnolia Ave Auburndale |
State: | FL US |
Postal Code: | 338234108 |
Phone Number: | 8635951440 |
Fax Number: | |
NPI Enumeration Date: | 07/13/2005 |
NPI Last Update Date: | 12/17/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | 1312052 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |