Organization
PONCE HOME MEDICAL EQUIPMENT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY PONCE MS (CEO OWNER)
(904) 826-0700
Entity
Organization
Contact information
Practice address
665 STATE ROAD 207, SUITE 108, SAINT AUGUSTINE, FL 32084-5938
(904) 826-0700
(904) 826-0800
Mailing address
PO BOX 3123, SAINT AUGUSTINE, FL 32085-3123
(904) 824-4990
(904) 824-2226
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
1313412
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032384500
—
FL
01
—
1313412
ACHA LICENSE
FL
01
—
1837478
AETNA
FL
01
—
326649
OXYGEN LICENSE
FL
01
—
613159000
OWCP - DOL
FL
Enumeration date
01/17/2008
Last updated
02/09/2009
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