NPIMap

Organization Active NPI

Florida Home Medical Supply LLC

Doing business as Colonial Medical Supplies

  • Durable Medical Equipment & Medical Supplies
  • Kissimmee, FL
National Provider Identifier
1114125143
Registry record updated May 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
FLORIDA HOME MEDICAL SUPPLY LLC
Doing business as
Colonial Medical Supplies
Practice address
1113 N Central Ave
Kissimmee, FL 34741-4405
Phone
(407) 849-6455
Fax
(407) 849-6458
NPI assigned
Jul 11, 2007
Last updated
May 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wendy Russalesi
Title
Cco
Phone
(484) 246-9499

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary
Oxygen Equipment & Supplies (DME) 332BX2000X 1313277 FL
Prosthetic/Orthotic Supplier 335E00000X NU

Addresses

Primary practice location

1113 N Central Ave
Kissimmee, FL 34741-4405

Mailing address

555 E North LN Ste 5075
Conshohocken, PA 19428-2490

Other identifiers 3

IdentifierTypeStateIssuer
1313277OtherFLHOME MEDICAL EQUIPMENT SUPPLIER
127860700MedicaidFL
327174OtherFLMEDICAL OXYGEN RETAIL SUPPLIER

Other names 1

  • Colonial Medical Supplies Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930044191 FL DME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Medical Supply CompanyDME Supplier - Orthotic PersonnelDME Supplier - Prosthetic PersonnelDME Supplier - Oxygen & Equipment 9133247026 Practice locations: Kissimmee, FL

National Provider Directory

National Provider Directory
Tax ID family
Florida Home Medical Supply LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 36

Organizations listed as members of this organization in the National Provider Directory.

View all 36

Locations

614 E Altamonte Dr
Altamonte Springs, FL 32701

1113 N Central Ave
Kissimmee, FL 34741
Phone (407) 849-6455

Networks

  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779840000000",
    "number": "1114125143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 E NORTH LN STE 5075",
            "city": "CONSHOHOCKEN",
            "state": "PA",
            "postal_code": "194282490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 N CENTRAL AVE",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347414405",
            "telephone_number": "407-849-6455",
            "fax_number": "407-849-6458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA HOME MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-11",
        "last_updated": "2026-05-27",
        "certification_date": "2026-05-27",
        "status": "A",
        "authorized_official_last_name": "RUSSALESI",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "484-246-9499"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "FL",
            "license": "1313277",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOME MEDICAL EQUIPMENT SUPPLIER",
            "identifier": "1313277",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127860700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL OXYGEN RETAIL SUPPLIER",
            "identifier": "327174",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Medical Supplies",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colonial Medical Supplies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.