Provider Demographics
NPI:1699093971
Name:MED PLUS OF NWF
Entity type:Organization
Organization Name:MED PLUS OF NWF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIPMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:850-240-0093
Mailing Address - Street 1:323 PAGE BACON RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MARY ESTHER
Mailing Address - State:FL
Mailing Address - Zip Code:32569-1610
Mailing Address - Country:US
Mailing Address - Phone:850-226-6331
Mailing Address - Fax:850-226-6332
Practice Address - Street 1:323 PAGE BACON RD
Practice Address - Street 2:SUITE 14
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569-1610
Practice Address - Country:US
Practice Address - Phone:850-226-6331
Practice Address - Fax:850-226-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies