| 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: | |