Organization
FOUR CORNERS MEDICAL SUPPLY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUIS B MENDOZA (PRESIDENT)
(352) 243-7477
Entity
Organization
Contact information
Practice address
1050 US HIGHWAY 27, SUITE 20, CLERMONT, FL 34714-7508
(352) 243-7477
(352) 243-7877
Mailing address
1050 US HIGHWAY 27, SUITE 20, CLERMONT, FL 34714-7508
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1312914
AHCA
FL
01
—
3204596
MEDICAL OXYGEN RETAILER
FL
Enumeration date
07/09/2006
Last updated
09/11/2025
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