Provider Demographics
| NPI: | 1114125143 |
|---|---|
| Name: | FLORIDA HOME MEDICAL SUPPLY LLC |
| Entity type: | Organization |
| Organization Name: | FLORIDA HOME MEDICAL SUPPLY LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | STEPHEN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GRIGGS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 407-206-0040 |
| Mailing Address - Street 1: | 220 W GERMANTOWN PIKE STE 250 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PLYMOUTH MEETING |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 19462-1437 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 610-630-6357 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1113 N CENTRAL AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | KISSIMMEE |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 34741-4405 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 407-849-6455 |
| Practice Address - Fax: | 407-849-6458 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-07-11 |
| Last Update Date: | 2022-06-14 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 332B00000X, 335E00000X | ||
| FL | 1313277 | 332BX2000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 332BX2000X | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | |
| No | 335E00000X | Suppliers | Prosthetic/Orthotic Supplier |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 327174 | Other | MEDICAL OXYGEN RETAIL SUPPLIER |
| FL | 001517300 | Medicaid | |
| FL | 1313277 | Other | HOME MEDICAL EQUIPMENT SUPPLIER |
| ID | 18070 | Other | DURABLE MEDICAL EQUIPMENT OUTLET REGISTRATION |
| PA | 6000008043 | Other | DRUG, DEVICE & COSMETIC REGISTRATION LICENSE |
| KS | 16-12156 | Other | DURABLE MEDICAL EQUIPMENT CERTIFICATE |
| AZ | 225012 | Other | WHOLESALER FULL SERVICE |
| UT | 8209591-1714 | Other | CLASS E PHARMACY LICENSE |
| FL | 1313277 | Other | HOME MEDICAL EQUIPMENT SUPPLIER |
| MI | 5306003688 | Other | MANUFACTURER AND WHOLSALER LICENSE |
| OR | NPC-0003757 | Other | MEDICAL DEVICE AND EQUIPMENT LICENSE AND GAS OUTLET |
| OK | OK-1897-FL | Other | GERMICIDAL TREATMENT PERMIT |
| FL | 001517300 | Medicaid | |
| MS | 10546/11.1 | Other | MEDICAL EQUIPMENT SUPPLIER PERMIT |
| FL | 32-6475 | Other | OXYGEN RETAIL SUPPLIER |
| CA | 57410 | Other | HOME MEDICAL DEVICE RETAILER LICENSE |
| IN | 69000964A | Other | HOME MEDICAL EQUIPMENT SERVICE PROVIDER |
| AZ | C000850 | Other | MEDICAL GAS SUPPLIER |
| OH | HMER 23007 | Other | HOME MEDICAL SERVICES PROVIDER LICENSE |
| NC | 01924 | Other | DEVICE AND MEDICAL EQUIPMENT DISPENSING PERMIT |
| VA | 0206009697 | Other | MEDICAL EQUIPMENT SUPPLIER PERMIT |
| AR | 065787 | Other | SUPPLIER OF MEDICAL EQUIPMENT, LEGEND DEVICES, MEDICAL GAS PERMIT |
| NH | 8154 | Other | LIMITED RETAIL DRUG DISTRIBUTORS LICENSE |
| AZ | C000850 | Other | MEDICAL GAS SUPPLIER |
