Organization Name: | MED PLUS OF NWF |
NPI Number: | 1699093971 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THEARON L SHIPMAN (OWNER) |
Mailing Address: | 323 Page Bacon Rd Suite 14 Mary Esther |
State: | FL US |
Postal Code: | 325691610 |
Phone Number: | 8502266331 |
Fax Number: | 8502266332 |
NPI Enumeration Date: | 05/11/2010 |
NPI Last Update Date: | 05/11/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BX2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Oxygen Equipment & Supplies |
Taxonomy Definition: |