Provider Demographics
NPI:1063567758
Name:NORTH FLORIDA OXYGEN AND MEDICAL INC.
Entity type:Organization
Organization Name:NORTH FLORIDA OXYGEN AND MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SID
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-401-0202
Mailing Address - Street 1:3380 SE LAKE WEIR ROAD
Mailing Address - Street 2:STE B
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6725
Mailing Address - Country:US
Mailing Address - Phone:352-401-0202
Mailing Address - Fax:
Practice Address - Street 1:3380 SE LAKE WEIR ROAD
Practice Address - Street 2:STE B.
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6725
Practice Address - Country:US
Practice Address - Phone:352-401-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1313210332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL326449OtherMEDICAL OXYGEN RETAILER
FL1313210OtherAHCA HME AND SERVICES
FL1313210OtherAHCA HME AND SERVICES