Provider Demographics
NPI:1528086568
Name:SEELEY MEDICAL OXYGEN CO OF FLORIDA
Entity type:Organization
Organization Name:SEELEY MEDICAL OXYGEN CO OF FLORIDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-671-7775
Mailing Address - Street 1:1029 S NOVA RD
Mailing Address - Street 2:UNIT H
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9021
Mailing Address - Country:US
Mailing Address - Phone:386-671-7775
Mailing Address - Fax:386-671-7422
Practice Address - Street 1:1029 S NOVA RD
Practice Address - Street 2:UNIT H
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9021
Practice Address - Country:US
Practice Address - Phone:386-671-7775
Practice Address - Fax:386-671-7422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL61332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL027325200Medicaid
FL027325200Medicaid