Provider Demographics
NPI:1871615195
Name:NATIONAL HOME MEDICAL
Entity type:Organization
Organization Name:NATIONAL HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-615-1011
Mailing Address - Street 1:13211 N NEBRASKA AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-2602
Mailing Address - Country:US
Mailing Address - Phone:813-615-1011
Mailing Address - Fax:813-615-1033
Practice Address - Street 1:13211 N NEBRASKA AVE
Practice Address - Street 2:SUITE G
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-2602
Practice Address - Country:US
Practice Address - Phone:813-615-1011
Practice Address - Fax:813-615-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9376332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR9880OtherBLUE CROSS BLUE SHIELD
FLR9880OtherBLUE CROSS BLUE SHIELD